Have you previously started an online application?
Please resolve the following issues before proceeding
Click on an issue to go directly to the related section of the form.
errors found:
warnings found:
Thank you, your National Emergency Medal application has been received. The Australian Honours and Awards Secretariat is responsible for verifying the details provided in all nominations. The Secretariat relies upon your primary service organisation to validate these details promptly. This process may take up to 12 months, and in some cases even longer. As the nominator, you will be informed in writing once a decision has been made. If any further information is required, you will be contacted by the Secretariat.

Next steps

You are required to complete these additional forms to finalize your request.
Your Tracking Code is:
Please quote your Tracking Code when enquiring about your nomination.

For your records

Would like a copy of this submission for your personal records?
OR

Check your email

We've sent a copy of your submission to your email address ().If you didn't receive it or would like another copy, just select one of the options below.
OR

Form Saved

National Emergency Medal Nomination Form
Your form has been saved and may be re-opened later.
Your Tracking Code is:
Please note that your saved form, if not updated or submitted within approximately 14 days will be deleted.

Send yourself a reminder email

Enter your email address and we'll send you instructions on how to return to your form.

Check your email

We've sent instructions to your email address () on how to return to the application when you are ready. If you didn't receive it or would like a reminder send to a different email address, just click the link below and follow the instructions.
Section 1
Our Honours System The Australian honours system celebrates the outstanding achievements and contributions of extraordinary Australians in a diverse range of fields and areas of endeavour. It's about recognising those people in the community whose service and contributions have had the effect of making a significant difference to Australian life or, more broadly, to humanity at large. Declaration The community expects recipients within the Australian honours system to be good citizens and role models. Awards may be reviewed for a variety of reasons, including criminal conviction and bringing the honours system into disrepute. Review can be based on past or future events. If you have any questions or concerns, you should raise these with the Secretariat at this time. Any information you provide will be treated confidentially. Privacy Statement Your privacy is important to us. We will only collect, use or disclose your personal information in accordance with the Privacy Act 1988. We want to ensure that personal information collected, used and stored is accurate and complete. We ask that you carefully check the information throughout the form for accuracy. The Australian Honours and Awards Privacy Statement can be found here. Further Information Further information about the National Emergency Medal can be found here.
Are you completing this application for yourself?
Your date of birth
Your gender
Would you like to provide your residential address?
You may enter an Australian or International address.
Would you like to provide your position/occupation details?
Would you like to provide your business address?
You may enter an Australian or International address.
Please provide as many of your phone details as possible *
Applicant's gender
Do you know the applicant's date of birth?
Applicant's date of birth
Are you able to provide the applicant's personal email address?
Are you able to provide the applicant's residential address?
To assist processing the nomination, please advise where the applicant resides
You may enter an Australian or International postal address.
Are you able to provide the nominee's position/occupation details?
Are you able to provide the applicant's business address?
You may enter an Australian or International business address.
Are you able to provide any of the following phone contact details for the applicant?
Section 1
To be completed
Which emergency did the applicant render service for?
Victorian Bushfires 2009 Service recognised during this nationally-significant emergency will be recognised through the clasp, ‘VIC FIRES 09’. The National Emergency Medal Committee determined the following criteria:
service must be in the protection of lives and property, or in the service of interests, that are not their own, in direct response to the emergency, including support that enables or facilitates the emergency response; the geographical area is the State of Victoria; the qualifying period begins on 28 January 2009 and ends on 5 March 2009; and the minimum duration of service that a person is required to have completed to qualify for sustained service is: - paid service on 14 days, including at least two days in the period beginning on 7 February 2009 and ending on 14 February 2009; or - unpaid service on 7 days, including at least one day in the period beginning on 7 February 2009 and ending on 14 February 2009.
Queensland Floods 2010-11 and Cyclone Yasi Service performed during the Queensland Floods and Cyclone Yasi will be recognised though the clasp, ‘QLD 2010-11’. The National Emergency Medal Committee determined the following criteria:
service must be in the protection of lives and property, or in the service of interests, that are not their own, in direct response to the emergency, including support that enables or facilitates the emergency response: the geographical State of Queensland; the qualifying period begins on 21 December 2010 and ends on 14 February 2011; and the minimum duration of service that a person is required to have completed to qualify for sustained service is: - paid service on 28 days; or - unpaid service on 14 days.
Bushfires 2019
Tropical Cyclone Debbie 2017 Service performed during Tropical Cyclone Debbie 2017 will be recognised though the clasp, ‘TC DEBBIE 2017’. The National Emergency Medal Committee determined the following criteria:
service must be in the protection of lives and property; or in the service of interests, that are not their own; in direct response to the emergency (including support that enables or facilitates the emergency response). the geographical areas in Australia consist of the following local government areas, as at 25 March 2017. New South Wales: Ballina, Byron, Clarence Valley, Kyogle, Lismore, Richmond Valley, Tenterfield, Tweed. Queensland:Banana, Brisbane, Bundaberg, Burdekin, Central Highlands, Charters Towers, Fraser Coast, Gladstone, Gold Coast City, Goondiwindi, Gympie, Hinchinbrook, Ipswich, Isaac, Livingstone, Lockyer Valley, Logan, Mackay, Maranoa, Moreton Bay, Noosa, North Burnett, Palm Island, Redland, Rockhampton, Scenic Rim, Somerset, South Burnett, Southern Downs, Sunshine Coast, Toowoomba, Townsville, Western Downs, Whitsunday, Woorabinda Aboriginal. the qualifying period begins on 25 March 2017 and ends on 10 April 2017; and the minimum duration of service that a person is required to have completed to qualify for sustained service is 5 days.
North Queensland Floods 2019 Service performed during North Queensland Floods 2019 will be recognised though the clasp, ‘NTH QLD 2019’. The National Emergency Medal Committee determined the following criteria:
service must be in the protection of lives and property; or in the service of interests, that are not their own; in direct response to the emergency (including support that enables or facilitates the emergency response). the geographical areas in Australia consist of the following local government areas, as at 25 January 2019. Queensland:Aurukun, Barcoo, Boulia, Burdekin, Burke, Cairns, Carpentaria, Cassowary Coast, Charters Towers, Cloncurry, Cook, Croydon, Diamantina, Douglas, Etheridge, Flinders, Hinchinbrook, Hope Vale, Kowanyama River, Lockhart River, Longreach, Mackay, Mapoon, Mareeba, McKinlay, Mornington, Mount Isa, Napranum, Northern Peninsula, Palm Island, Pormpuraaw, Richmond, Torres, Torres Strait Island, Townsville, Whitsunday, Winton, Wujal Wujal, Yarrabah. the qualifying period begins on 25 January 2019 and ends on 14 February 2019; and the minimum duration of service that a person is required to have completed to qualify for sustained service is 5 days.
Which criteria is the applicant to be considered under?
Upon receipt, nominations for significant service are researched and prepared by the Australian Honours and Awards Secretariat for presentation to the National Emergency Medal Committee. The Committee considers whether the nominee’s service: was part of the response efforts to the nationally-significant emergency: assisted with the protection of lives and property; was extraordinary.

Period

Please note: This nomination may meet the criteria for ‘sustained service’ rather than ‘significant service’. You may wish to select ‘sustained service’ on the nomination form instead of ‘significant service’. Alternatively, after initial assessment, the Australian Honours and Awards Secretariat may process your nomination under the ‘sustained service’ criteria.
Section 1
Referee details Please provide the details of at least one person who can verify the contribution/sevrice of the person you are nominating.

Referee

You may enter an Australian or International address.
If known, please provde as many phone contact details.
What prompted you to nominate
National Emergency Medal Application Form | Governor-General of the Commonwealth of Australia