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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. The validation 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. The Secretariat will contact you if further information is required.

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National Emergency Medal Nomination Form
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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. Your informationTo maintain the integrity of the Australian Honours and Awards System we must positively identify you. If you choose not to provide your personal information, then the Australian Honours and Awards Secretariat may not be able to administer your award/s, or respond to your request. We want to ensure that personal information collected, used and stored is accurate and complete.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.
Is the applicant a member of the Australian Defence Force, Queensland Fire and Emergency Services, NSW Rural Fire Service, Fire and Rescue NSW, Country Fire Authority Victoria, or Queensland Police Service?
•Australian Defence Force members and units are not required to submit a nomination for the National Emergency Medal. A consolidated list of nominations will be provided by the Department of Defence.•Queensland Fire and Emergency Services members are not required to submit a nomination for the National Emergency Medal. For further details, please contact Honours and Awards, Queensland Fire and Emergency Services.•Queensland Police Service members are not required to submit a nomination for the National Emergency Medal. For further details, please contact Honours and Awards Unit, Queensland Police Service.•NSW Rural Fire Service members are not required to submit a nomination for the National Emergency Medal. A consolidated list of nominations will be provided by NSW RFS.•Fire and Rescue NSW members are not required to submit a nomination for the National Emergency Medal. A consolidated list of nominations will be provided by the Office of the Commissioner, Fire and Rescue NSW.•Country Fire Authority Victoria members are not required to submit a nomination for the National Emergency Medal. A consolidated list of nominations will be provided by CFA VIC.
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 performed during the Victorian Bushfires 2009 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 2019-20Service performed during the bushfires that happened in New South Wales, Victoria, Queensland, South Australia or the Australian Capital Territory, between September 2019 and February 2020 will be recognised through the clasp, 'BUSHFIRES 19-20'. The National Emergency Medal Committee determined the following criteria: •service must be in protection of lives and property; or in the service of interests that are not their own; in direct response the declared emergency (including support that enables or facilitates the emergency response).•the geographical area in Australia where the declared emergency happened, are the Local Government Areas (LGA) listed in Schedule 1.•the qualifying period for each local government area is listed in Schedule 1.•the minimum duration of service that a person is required to have completed to qualify for sustained service is 5 days (whether consecutive or not) each involving service in direct response to the declared emergency relating to a Schedule 1 local government area in an eligible emergency period for the area.
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 for?
Sustained Service
The Australian Honours and Awards Secretariat is responsible for verifying the information provided, to determine if the service has met the sustained service requirements of the criteria for the relevant emergency. The Governor-General may approve an award for sustained service on the recommendation of the Australian Honours and Awards Secretariat.Significant Service
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.
Did the applicant render service as a member of an organisation/s or as an individual?
Member of organisation/s
If the applicant rendered service with a group, agency or primary service organisation: •Please contact your primary service organisation to express your interest in being considered for the National Emergency Medal. Your primary service organisation will consolidate applications, verify each applicant’s service and submit the applications to the Secretariat for processing.Individual
If the applicant rendered service as a private citizen in a voluntary capacity and did not render service as a member of any group, agency or primary service organisation, please select 'Individual'.
Evidence of service renderedAs the applicant rendered service in a private capacity, we need as much information as possible to verify the service. Please provide evidence from a local government agency, community group, emergency services agency or other relevant persons, to verify the applicant's service. This should be on letterhead and include the following information: •Role/position during the nationally-significant emergency; and •Brief description of service.
Please attach evidence documents here.
File:

Period

As there are two separate qualifying periods for the State of Queensland, please select the appropriate period by choosing option QLD - P1 for 6 September 2019 - 17 September 2019, and QLD - P2 for the period 9 November 2019 - 23 November 2019.
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.
What prompted you to nominate
National Emergency Medal Application Form | Governor-General of the Commonwealth of Australia