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Department of Premier and Cabinet

Honour Roll nomination form

Section 1: Nominee

Tell us about the woman you are nominating for the Honour Roll.

  • If you are unsure of the spelling of any names, please mark the name with a hash (#).
  • Fields marked with an asterisk (*) are compulsory and must be filled in before the nomination can be submitted.
  • If this is a posthumous nomination, please give details of a next-of-kin contact (if known) in the address, phone number and email address fields.

(Miss, Mrs, Ms, Dr, Prof etc)



(if posthumous nomination)

(if known)




Employed:


eg 26/05/1955

Town/suburb - State/country

eg 26/05/1955

Town/suburb - State/country

Please select the category that best suits the nominee's area of excellence: *


Section 2: Nominator

Please provide your contact details to enable Women Tasmania to seek further information if required.


Mr, Mrs, Miss, Ms, Dr etc










Please note

  • Nominations are now open for induction into the Honour Roll in 2017.
  • Nominations close in September 2016.
  • An independent judging committee will assess all nominations to determine the nominee’s suitability for inclusion on the Honour Roll. It is advisable to include as much detail as possible to assist the judges in reaching a decision.
  • You are encouraged to supply any supporting information such as newspaper or newsletter articles.

Section 3: Details about nominee's contribution to the community

In this section you will provide details of your nominee’s significant contribution to the community, achievements and work history (paid and voluntary) including any positions held / activities undertaken and the relevant dates of service. Also provide a brief statement about why you think this woman deserves recognition on the Tasmanian Honour Roll of Women.

In preparing your statement, review the selection criteria for the Tasmanian Honour Roll of Women.

Please complete this section as a separate Word or PDF document and send as an attachment with your nomination form. If you fail to attach a document here an automatic prompt will appear before you can submit your nomination form.


Nomination process and selection criteria

Organisations and individual members of the Tasmanian community are invited to nominate women they consider to have made a significant contribution at a local, state or national level in their field of endeavour.

Nominees must be nominated by an individual other than themselves or by an organisation.

Posthumous nominations are accepted.

Supporting information is required and should be typed and not exceed 500 words.

Selection of new members will be guided by the following criteria:

  • significant contribution to the Tasmanian community
  • an inspirational role model for all Tasmanian women
  • personal, academic and professional achievements - past and current
  • key achievements in advancing social justice
  • contribution in their relevant field
  • contribution to the development of regional communities
  • degree of difficulty of the achievement
  • voluntary activity - nature and length of involvement

A panel of judges appointed by the Minister will base its decision on the selection criteria. Nominations should address as many of the selection criteria as possible.


Personal Information Protection Act 2004

The Tasmanian Honour Roll of Women is maintained in accordance with the Personal Information Protection Act 2004, which establishes a framework for the responsible collection and use of information by the Tasmanian public sector. All information provided by nominees and nominators is confidential and will only be used for the purpose of assessing Honour Roll nominations.

For those selected for inclusion on the Honour Roll, some of the information nominators provide will be used to develop a biography suitable for publication in a commemorative folder and on the Communities, Sport and Recreation website. As part of that process, each inductee, or their representative, will be asked to confirm the accuracy of her biography.

To find out more about the Honour Roll, including previous inductees, visit the Honour Roll homepage or contact Communities, Sport and Recreation on 6232 7108 or email honourroll@dpac.tas.gov.au or csr@dpac.tas.gov.au

 I declare that the information given on this Nomination Form is true and correct to the best of my knowledge: *