Online Form - Clem Kentish Community Service Award - Nomination Form

The Clem Kentish Community Service Award aims to recognise long standing contributors to the Shire of Serpentine Jarrahdale community. In order to be considered for this prestigious award, the person being nominated must demonstrate the following:

Guidelines for the Award

  1. Minimum length of service to the community is to have been at least twenty (20) years.
  2. Nominee is to have served on several committees that have benefited the community.
  3. Nominee is to be a resident of the Shire of Serpentine Jarrahdale.
  4. Either organisations or individuals may make nominations for the award.
  5. Winner is to be presented with a lapel badge and plaque at the Shire of Serpentine Jarrahdale’s Australia Day Awards’ Ceremony.

Completed forms must be submitted by Monday, 31 October 2022.

Details of the person being nominated (Confidential)

Has the person contributed at least 20 years of service to the community? *

Other persons who may be contacted for further information about nominee

Person 1

Person 2

To be completed by the person submitting the nomination

Would you like to remain anonymous to the person you are submitting as a nominee? *