Police Officer of the Year award – Nomination Page

Rotary NT Police Officer of the Year

Nomination Form

This is your opportunity to acknowledge acts of courtesy, kindness, understanding, compassion, courage or devotion to duty by any member – male, female, uniform or plain clothes – of the Northern Territory Police during 2016.

Nominee

Name: *

Rank: *

Location: *

Reason for nomination *

(please supply as much information as you can including examples of how they made a difference)

Nominator

Name: *

Address: *

Phone No.:

Do you want to remain anonymous? Yes No

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