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Recognition of Service to Local Government Form

Required fields are marked with an asterisk (*).

Important notes

  • The LGA needs a minimum of 6 weeks notice to post requested service certificates to councils.
  • Certificates for Elected Members who have served local government for 20 years or more can be presented at the next LGA event opportunity.
  • You will receive a confirmation email after successfully submitting this form. Please verify that you receive this email to confirm your submission was successful.
  • If you would like to do a bulk submission (for more than 10 service certificates), email awards@lga.sa.gov.au for a customised spreadsheet instead of using this form.
  • For any support on these awards please email awards@lga.sa.gov.au

Complete this form in sentence case. (Please do not use all capitals.)

Recipient details
Select the nominees title below if relevant. (If it is not a title listed here, please add to first name field below.)
Provide any post nominal letters to be printed on the certificate (ie OAM).
Write the full name of the recipient's council. (To be printed on the certificate.)
Category of Recognition of Service
Select if the recipient is currently serving as an Elected Member, staff member or volunteer to the council.
Was the service continous?

Elected Members who have completed 20 years or more of service

The LGA recognises the significant contribution from Elected Members who have completed 20 years or more of service to local government. The LGA can present the Elected Member with a framed certificate at an agreed event opportunity.

The following section of questions only need to be completed to assist the LGA with a presentation for the Elected Member.

Only for Elected Members with 20+ years of service
Would the nominated Elected Member like to be presented the certificate at the next LGA event opportunity? If you select no, there is no need to complete the rest of this section. Please skip to the next section.
For presentation purposes - Outline the nominated Elected Members key achievements and any other key information about their service to local government and their community. (Approx 2 paragraphs)
For presentation purposes - Upload a profile picture of the nominated Elected Member. (Preferably a high resolution jpeg)
Key contact person

Delivery timeframes

All service certificates (other than Elected Members being presented at an LGA event) will be posted to the council for presenting.

Please allow 6 weeks as a minimum for certificates to be delivered.  Email us at awards@lga.sa.gov.au for any questions about Service Certificates.