Engagement Programs
2016 Nomination form
Nominations close: 5pm, Friday 12 August 2016
Nominations can be for completed for ongoing programs where the activity occurred between 1 July 2015 – 30
June 2016.
Programs can include (but are not limited to) the following:

Community involved and culturally inclusive programs

Innovative programs that meet your program or organisation’s priorities and objectives

Programs strategically linked to school activities and the curriculum

Corporate partnerships that have extended and developed audiences

Capacity building programs that have increased repeat visitations

Education resources and related in-house publications

Innovative website and/or social media projects
Please tick the box for the award to which you are applying
(A) Engagement Programs award for volunteer organisations with 2 or less paid staff in the entire
organisation
(B) Engagement Programs award for small/medium organisations with 3 -10 staff in the entire organisation
(C) Engagement Programs award for large organisations with 11 or more paid staff in the entire organisation
Selection criteria
1. Quality of the program’s aims and achievements
2. Quality of evaluation processes and outcomes
3. Level of consultation with stakeholders
4. A well planned program that is clearly articulated
Engagement Programs 2016
Nomination details
Name of museum, gallery or Aboriginal cultural centre being nominated for the award:
Title of program:
Nominator details (Person completing this form)
Nominating Organisation (if different from above)
Contact person:
Position:
Phone:
Email:
Street address:
Suburb:
State:
Postcode:
Postal address:
Suburb:
State:
Postcode:
Full time paid staff equivalent that worked on this program:
Number of volunteers that worked on this program:
Program budget:
Engagement Programs 2016
Annual visitation:
Program details
Provide a short description of your organisation (max. 200 words)
You may wish to include your organisation’s mission statement/vision
Briefly describe the program (max. 100 words)
Who was the intended audience and what were the aims? (max. 100 words)
How successful were you in reaching your target audience? (max. 500 words)
Be qualitative and quantitative in your analysis
In what way was this program innovative? (max. 200 words)
Engagement Programs 2016
Support material
The following support material must be submitted with your nomination:

FIVE images or pages (maximum) of documentation which supports the application
Support Material details (i.e. image details, name of document)
1
2
3
4
5
AND

TWO high quality images of the nominated program (300 dpi jpegs max. 2MB). These images will be
used in promotional material and at the awards presentation.
Image
No.
1
2
Image credit for promotional use
Please refer to the 2016 Guidelines for details on how to prepare and submit your support material.
Declaration by nominator
I give my assurance that, to the best of our knowledge, the information supplied in this nomination is true and
correct at this date. I agree to abide by the IMAGinE awards’ Terms and Conditions of Entry.
I accept.
Date:
How to submit your nomination
Nominations and support material are to be submitted in an electronic format by email or post on USB or CD.
Nominators who are unable to submit digital material must contact M&G NSW to discuss alternate
arrangements.
To prepare your entry for submission save this document with your organisations name and category you are
entering. Please use an underscore ( _ ) to separate words. For example: OurMuseumGallery_Engagement.doc
Engagement Programs 2016
Nomination checklist
Completed nomination form
Completed payment details page
Required support material
Please submit your nomination to Museums & Galleries of NSW
Email submissions:
[email protected]
Posted USB/CD submissions:
IMAGinE award nominations
Museums & Galleries of NSW
Level 1, The Arts Exchange, 10 Hickson Road
The Rocks NSW 2000
Engagement Programs 2016
Nominating organisation payment details
Organisation:
Contact person:
Position:
Postal address:
Suburb:
State:
Postcode:
Phone:
Email:
(Invoice/receipt will be sent to this address)
Entry fee levels
$30 – (A) Volunteer organisations with 2 or less paid staff
$40 – (B) Small/medium organisations with 3 – 10 paid staff
$50 – (C) Large organisations with 11+ paid staff
Total entry fee: $
(Including GST)
Payment Information
Payment method:
Cheque
Invoice
Visa
Credit card no:
CVC:
Card holder:
Expiry date:
Mastercard
Terms and conditions
Tax invoices will be issued for all nominations. Nominations are not accepted without payment. Nomination
fees are non-refundable. Your personal information will be stored in accordance with M&G NSW’s privacy
policy. If you have any concerns please contact M&G NSW on 02 9252 8300 or [email protected]
Engagement Programs 2016
Award Night Early Bird Ticket Offer
Attendee Information
First name:
Surname:
Position:
Organisation:
Address:
Email:
Phone:
Fax:
Dietary requirements:
Event Costs
$58.50 (including GST) Early Bird Full price
$40.50 (including GST) Early Bird Concession price (volunteers, students and seniors)
Payment Information
Payment method:
Cheque
Invoice
Visa
Credit card no:
CVC:
Card holder:
Expiry date:
Email:
Mastercard
(Invoice/receipt will be sent to this address)
Terms and conditions
Tax invoices will be issued for all registrations. Registrations are not accepted without payment. Cancellations
may incur a $15 administrative fee. Cancellations must be made more than three working days prior to the event
or refund may not be issued. All details are correct at time of printing. For additional information please contact
02 9252 8300 or [email protected].
Award Night Early Bird Ticket Offer
Award Night Attendee Statistical Information
M&G NSW values your privacy. Your responses to the following questions will not be used for any other
reason than statistical research and will remain grouped. No identifying information will ever be used.
Region
Age
Gender
Extra
Metro Sydney
15-25
Male
Disability/special needs
Western Sydney
26-40
Female
Non-English speaking background
Regional NSW
41-65
Other
65+
Aboriginal or Torres Strait Islander
How did you hear about this event?
M&G NSW e-newsletter Alert!
Other e-newsletter
M&G NSW website
Other website
Word of mouth
Direct email
Other (please specify)
Would you like to subscribe to Alert! M&G NSW’s fortnightly e-newsletter?
Yes, please subscribe me
No, I do not want to be subscribed
No, I am already subscribed
Return Information
Museums & Galleries of NSW
Level 10, The Arts Exchange, 10 Hickson Road, The Rocks NSW 2000
Email: [email protected]
Award Night Early Bird Ticket Offer