Nomination Form - Closing 5 pm Friday, 26 April 2019

We encourage nominations from regional, rural and remote areas.

This award recognises an organisation who has made an outstanding contribution to the palliative care sector, using innovation and best practice to enhance the delivery of palliative care.  Organisations must submit documented evidence of the strategies deployed and the outcomes, as well as a short video presentation (mp3 format).
This award is open to organisations providing palliative care and/or support services to people living with a life-limiting illness and their families including palliative care units, hospices, hospitals, aged care services, disability services, volunteer services, community or home care services.

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* 1. Details of the Organisation

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* 2. Provide a brief background of the organisation and the area in which it works

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* 3. How has the organisation demonstrated an outstanding contribution to the palliative care sector as outlined in this category?

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* 4. Details of the Nominator

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* 5. Has the organisation granted consent for their nomination?

SUPPORTING DOCUMENTATION
Please email supporting documentation to events@palliativecarewa.asn.au
DECLARATION
I attest that all the information provided on this form is accurate and true to the best of my knowledge.

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* 6. Name

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* 7. Date

Date / Time
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