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Awards and Ceremonies
Cockburn Sports Hall of Fame
Sports Hall of Fame Nomination
Sports Hall of Fame Nomination
Listen
The City’s Sports Hall of Fame celebrates outstanding achievements of local Cockburn athletes and sports administrators, past and present, along with the junior clubs that helped to develop their talents.
Please review the
Sports Hall of Fame Nomination Guidelines
page before completing this form.
Ensure all fields are completed. Incomplete applications will not be accepted.
Nominations close at
4pm on Friday 15 December 2023
. All submissions must be received by the City before this time.
Print Form
Sports Hall of Fame
All fields are required except where indicated
Person making this nomination
If the City of Cockburn requires more information you will be contacted.
First Name:
Surname:
Contact Number:
Email:
Are you nominating:
Yourself
Someone else
If you are nominating someone else, are they aware of your nomination? (if applicable):
Yes
No
Nominee details
First name:
Surname:
Date of Birth:
Calendar
Address:
Number of years at this address:
Contact number:
Nominee previous address (if applicable)
If the nominee currently resides outside the city of Cockburn, please indicate previous Cockburn addresses and length of time spent at those addresses.
Previous Cockburn addresses :
{"ActionText":"Address","Columns":[{"Id":"71dd069d-0cb0-45f4-b45d-783344c47396","ColumnName":"Full address"},{"Id":"5705ac55-90d0-4c6b-ae2e-f05635b5a3fd","ColumnName":"Date from<br>(MM/YYYY)"},{"Id":"1712c814-7eaf-4b41-a5e6-ad384106da4d","ColumnName":"Date to<br>(MM/YYYY)"}],"Rows":[]}
Cockburn Sporting Club Involvement (if applicable)
Please provide information relating to any involvement with sporting clubs based within the City of Cockburn.
{"ActionText":"Item","Columns":[{"Id":"e799011e-1b56-484d-b8c9-21d33fa39fa7","ColumnName":"Type of Sport"},{"Id":"fa5db1e6-c431-4c34-bedb-6f06050e2791","ColumnName":"Cockburn club/s<br>represented"},{"Id":"8d3e7e84-a588-4a07-a092-7d4fea81777c","ColumnName":"Year to Year"}],"Rows":[]}
Competitions attended (if applicable):
Include information such as the event name, date, and age group competing in, placings, etc
Administrative and Support Involvement (if applicable):
Provide details of any committee, coaching or other club administrative roles, including the length of time served in these roles.
State, National, and International Performance
Provide all information relating to the nominee’s representation in sports at either state, national or international levels.
What sport was the Nominee representing with their achievements?:
State competition (if applicable):
{"ActionText":"Item","Columns":[{"Id":"98f6678c-bf8e-4fd2-ba69-0f8f4dcae2c9","ColumnName":"Year Competed"},{"Id":"56fc8d4d-f4cd-49f0-b264-5db4058269d8","ColumnName":"Competitions Names<br>attended"},{"Id":"e76f5c05-059c-4197-b652-b45cc0df832f","ColumnName":"Best or highest<br>ranking/result"}],"Rows":[]}
National Competitions (if applicable):
{"ActionText":"Item","Columns":[{"Id":"8270d7bf-e2c8-459d-bff8-8449f92e8a73","ColumnName":"Year Competed"},{"Id":"e890ae34-6840-462b-94d2-312d9db2fa7c","ColumnName":"Names of<br>competitions attended"},{"Id":"22e975a2-ce85-4847-9efc-37a979473bc4","ColumnName":"Best or highest<br>ranking/result"}],"Rows":[]}
International Competitions (if applicable):
{"ActionText":"Item","Columns":[{"Id":"44b2d535-00e3-4e8c-9abf-e9ba01824b9f","ColumnName":"Year Competed"},{"Id":"7fca3c4c-935f-4557-8013-f81c383c67fd","ColumnName":"Names of<br>competitions attended"},{"Id":"4c95b2b4-07b8-433e-a102-b35dfa02b2a4","ColumnName":"Best or highest<br>ranking/result"}],"Rows":[]}
Further details and supporting information (if applicable):
NB: Provide any other details to support your nomination of this person to the Sports Hall of Fame.
Major Accomplishments/Milestones (if applicable):
NB: Provide details of any other accomplishments, such as names of other awards and the year awarded, and any other information available.
Supporting Documents (if applicable)
Additional Information
If required, please provide additional information on your attachment, for example, where a photo was taken and names of other people in the photo:
Supporting Documents (if applicable):
Supporting Documents (if applicable):
Supporting Documents (if applicable):
Supporting Documents (if applicable):
Supporting Documents (if applicable):
Declaration:
I agree that I have read the City of Cockburn Sports Hall of Fame Nomination Guidelines before completing this form. By submitting this application, I declare all information provided is true and correct to the best of my knowledge.
Read the Sports Hall of Fame nomination guidelines
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