Nominee's Name*

Association with La Trobe Sport* Please select... Elite Athlete Sport Club Sport Volunteer Coach Non-Elite Athlete Other

Nominee's Contact Number*

Nominee's Email Address

Please select which award you are nominating for :*

Reason for nomination, providing evidence and addressing key criteria * Please provide a summary detailing your reason for nomination and attach any supporting evidence below:* Max. 255 characters

REQUIRED: Supporting documentation 1 if available please include written references, records of results and achievements, or any imagery of your nomination.*

OPTIONAL: Supporting documentation 2 if available please include written references, records of results and achievements, or any imagery of your nomination.

OPTIONAL: Supporting documentation 3 if available please include written references, records of results and achievements, or any imagery of your nomination.

Name*

Contact Number*

Email*

Relationship to Nominee*

Have you read the Selection and Nomination Criteria?*

Has your nominee won an award at the Uni Blues Awards Night before?* Please select... Yes No Unsure

If yes, what year?