Matilda Award for Cultural Excellence nomination form

Information of person who is nominating a candidate

Full name Student/Staff Number Address Work Email

Information of person or members of a group who is being nominated for the Bryant Stokes Matilda Award

Full name Student/Staff Number Address Work Email Mobile Other

Field in which nomination is made

Nominations Music Dance Literature & Creative Writing Visual Arts & Design Public Speaking Theatre & Television Other (please specify below) Other nomination field Briefly state why you believe the award should be conferred upon the nominee List the various achievements of the nominee in this field Include any other information that you believe may assist the committee in its deliberation If you plan to include any examples of the nominee's work, or other supporting documentation, please attach them here