Youth Initiative Award Nomination Form

This annual award is named in honour of the late Ian De La Rue OAM, a driving force in the establishment of the Warburton Community Bank and its first Chairman.

It is to encourage, recognise, acknowledge and reward a young person who is active in and makes a positive contribution to their local community.

This is a Youth Initiative of Upper Yarra Community Enterprise Ltd made possible by the generous support of the Community Bank Warburton & Yarra Junction branches.

Nominee Information

Details of the person being nominated

Nominee’s must live, study or work in the Upper Yarra region defined as postcodes of 3799 and 3797 and the towns of Hoddles Creek, Launching Place and Don Valley
Live in the Upper Yarra region?
Study in the Upper Yarra region?
Work in the Upper Yarra region?
Please list clubs, organisations or groups where community contributions have been made and include role (example; Club Captain, Yarra Junction Junior Netball Club; Student Representative Council member, Warburton Primary School)

Nominator Information

Details of the person making the nomination

RELATIONSHIP TO NOMINEE You must be a teacher, employer, coach, mentor, committee member or other individual who has worked directly with the nominated person in a community capacity and recognises their potential
E.g. of you selected Employer specify the organisation's/company name.

Please detail the reasons why you are nominating this person. How have they made, or continue to make a positive contribution to the community for the benefit of others?