Commemorative Memorials and Plaques application form

Please use this application form to memorialise a deceased person, a folded association or final event that resided/was based/occurred within the City of Stirling, that has made a significant contribution to the City and their community.

Applications should only be submitted for consideration where there is demonstrated evidence that the person, event or association has significantly contributed to the cultural and social development of the City and its community.

Applicants are required to read the City’s Commemorative Memorials and Plaques Policy prior to ensure their application meets the selection requirements, understands the application process and fees associated, should the application be approved.

Applicant details

Please provide your information as the applicant.

First name*

Last name*

Street address*

Suburb*

Daytime contact number*

Email*

Preferred contact method*

PhoneEmail

Nominee details

Please provide information about the nominee you'd like to be recognised.

Name*

Date of birth*

Deceased date*

Years of residence within City of Stirling*

Upload proof of residence*

Significant contribution to the City and its community

Please address each category below by providing a description of the significant contribution the Nominee has made. You will be asked to provide any available documentation to confirm the Nominee’s contributions.)

The person, association or event resided/was based in the City of Stirling for a significant period (greater than 10 years)*

The person, association or event has demonstrated evidence of outstanding achievements and significant contributions and/or had a long-standing history with the development of the City or the community*

The person, association or event contributed to three or more sectors e.g. sport, education, arts, culture, youth, seniors, etc.* association or event contributed to three or more sectors e.g. sport, education, arts, culture, youth, seniors, etc.*

The person, association or event had a relevant relationship to the proposed site and has a long-standing association with that area.*

Please upload any supporting documents or photographs

Type of recognition

Please provide information on the location and the type of recognition you are seeking.

Please select the type of recognition you are applying for*

Commemorative bench
Commemorative plaque
Commemorative tree
Other

Location of recognition*

I have read the City’s Commemorative Memorials and Plaques Policy

I understand if this application is accepted and progressed, the details provided will be recorded in the City’s Collection Management System and will be made available to the Public

I have contacted the relevant Nominee’s family/contact and have their approval to submit this application.

Please provide proof of approval*

Once your Application is received you will receive a formal notification from the City confirming receipt of the application along with an estimated timeframe of a formal response regarding the applications eligibility
If approved, the City will confirm the design and format of commemorative memorial or plaque, purchase and ongoing maintenance and repair and replacement and removal responsibilities.

Commemorative Memorials and Plaques application form

Applicant details

Nominee details

Significant contribution to the City and its community

Type of recognition

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