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New Zealand Down Syndrome Association


National Achievement Awards

The NZDSA is calling for nominations for the NZDSA 2010 National Achievement Awards.
These awards recognise the accomplishments of people with Down syndrome during 2009.

 All nominations must be received by 18 January 2010

 The awards will be announced in March 2010 at our National T4T event to celebrate
World Down Syndrome Day (WDSD).
 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.

Name of Nominee: ____________________________________________________

Address: ____________________________________________________________

Tel: ________________________ Email ______________________________

Member of NZDSA : Yes/No Age (On 31 December ‘09): _____________________

Nominee’s Achievement(s) in 2009

Achievement/s: __________________________________________________________

Date: ___________________ Venue: ____________________________________

Please submit a written description (between 300 - 500 words) stating why the
nominee should be recognised.
This description can include details about the achievement/s of the nominee in 2009 as
well as providing a detailed overview of the nominee, which can include previous
achievements, hobbies, interests, recreation activities, or academic achievements.
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: Email to:

Linda te Kaat Linda te Kaat
P O Box 4142
Nominations must be received by 18 January 2010