The NZDSA is calling for nominations for the NZDSA 2015 National Achievement Awards.
These awards recognise the accomplishments of people with Down syndrome during 2014.
 All nominations must be received by 27th February 2015
 The awards will be announced at a National Achievement Award Event
 This form may be completed by a person with Down syndrome or by a relation, friend,
community leader or colleague of a person with Down syndrome.
 Nominees must be members of the NZDSA
Name of Nominee: ____________________________________________________
Address: ____________________________________________________________
Tel: ________________________
Email ______________________________
Age (On 31 December ‘14): _____________________
Name of nominator _____________________________________________________
Tel: ___________________________ Email _______________________________
Nominee’s Achievement(s) in 2014
Achievement/s: __________________________________________________________
Date: ___________________
Venue: ____________________________________
Please submit a written description (between 300 - 600 words) stating why the nominee
should be recognised.
This description should include details about the achievement/s of the nominee in
2014 as well as providing a detailed overview of the nominee, which can include
previous achievements, hobbies, interests, recreation activities, or academic
Please attach a photograph of the nominee.
Referee: (Someone who can confirm the details of the achievement/s)
Name: ________________________________ Tel: _____________________________
Address: _______________________________________________________________
I agree that my story can be published in the NZDSA Journal and I am willing to participate in
national media.
Signed by person nominated __________________________Date____________________
Signed by guardian _________________________________ Date_____________________
Post to:
Linda te Kaat
P O Box 4142
Email to:
Linda te Kaat
[email protected]
Nominations must be received by 27th February 2015