The Max Gardner Award for Distinguished Service is a prestigious award presented by Prostate Cancer Foundation of Australia (PCFA). It is awarded to an individual member of the Network that has made an outstanding and significant contribution to reducing the impact of prostate cancer on Australian men, their partners and families.

Please note: nominations cannot be received from the nominees themselves, nor a partner or family member. If you are completing a nomination on behalf of a Support Group please provide a single point of contact.

Please outline details of two referees, including a brief statement of support. For example: a member of an Affiliated Support Group, community group (e.g. Rotary, sporting club), a health professional and/or community leader (e.g. local MP’s). Please keep statements of support to 50 words or include as one of the key supporting documents below. Please summarise your statement of support prior to attaching a separate document.

Please tell us of any relevant information about:
•The nominee’s experience with prostate cancer
•The period of time the nominee has been making a contribution
•How the nominee became involved in the Support Group, or as a PCFA volunteer
Please include dates wherever possible. Attach additional paper work if necessary.

Describe the overall impact your nominee has had on others, locally and nationally, with the aim to achieve our vision and mission while demonstrating the PCFA values of integrity, optimism, compassion, respect and commitment towards others. Consider examples of:

·       Opportunities the nominee has taken beyond their Support Group role

·       How your nominee connects with the broader community and how their efforts have reached further afield including the state/territory and nationally.

·       Your nominee’s supportive involvement with disadvantaged/higher needs groups – e.g. Younger, Gay/Bi, Culturally and Linguistically Diverse, Partners/Carers, Aboriginal or Torres Strait Islander, Regional/Rural and Advanced Cancer

Please include dates wherever possible and use the 'attach file' option or Key Supporting Documents with an additional document.

Please include relevant documents with this form including a brief description of each below. Documents may include:
•Evidence the nominee’s contribution has been recognized elsewhere by media, government/ professionalgroups or by other awards.
•A letter of support from a support group/community group.