Palliative Care Australia

Click to expand navigation

Print Page Print this page

Nomination Form

Nomination Form

    A. Nomination Type

  • B. Award Categories

  • C. Contact details (for individual nominee or team lead)

  • D. About the nomination

  • E. Previous Engagement with the National Palliative Care Awards

  • F. Privacy Notice

  • Palliative Care Australia (PCA) will always take reasonable steps to ensure your personal information is handled in accordance Australian Privacy Principles (APPs) contained in the Privacy Act 1988 (Cth) (Privacy Act) when handling all personal information provided for nomination purposes. For information about the PCA’s privacy policy, please go to
  • As part of the nomination process PCA collects the personal information identified on this form. Where the nomination is on behalf of another person, the information above is collected about that person. If this information is not collected, the application will not be assessed. Please notify the PCA by email if the contact information required in this form changes.
  • Personal information is collected to assess eligibility for an Award, and to undertake statistical analysis in relation to the Awards program. PCA may also use this information to maintain an ongoing relationship with nominees, award prizes and invite nominees to relevant events and programs.
  • By nominating for an Award or providing information in support of a nominee’s application, you acknowledge and consent to PCA disclosing your personal information to the following persons and organisations institutions, PCA’s board, the persons assessing the nominations and the event and program contractors performing services on behalf of PCA.
  • PCA may also publish successful nominees’ information (excluding details) in media releases, presentations, conference programs, booklets about the Award recipients and on the Australian Palliative Care Conference 2017 website and the PCA’s website.
  • PCA will not use or disclose personal information for any other purpose unless permitted by the Privacy Act 1988.


National Palliative Care Service Directory

Search our directory to find palliative care providers near you.

Find a service provider

Register your service



Palliative Matters


News and Events