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Citizen of the Year Award Nomination Form

The Town of Tillsonburg is receiving nominations for the annual Citizen of the Year Award. Nominations will close Monday, March 31, 2025, at 4:30 p.m.

This award is presented to an individual who makes an outstanding contribution to the Town of Tillsonburg, with no expectation of personal gain. Volunteering of personal time and talent towards the betterment of our community are hallmarks of this award. Nominees can be recommended either for outstanding contributions to the community in the past year, or over a number of years.

The Town of Tillsonburg's Museum, Cultural, Heritage and Special Awards Advisory Committee will review all nominations, giving consideration to:

The length and impact of service
The uniqueness of the nominee's efforts
The extent to which the nominee supports and involves other people
The challenges and/or barriers the nominee has overcome in order to contribute

All nominations received within the last three years will be re-considered for this year’s award.

As the Nominator you are required to confirm the Nominee's willingness to be considered for the award.

Any questions or concerns related to the nomination process should be directed to the Office of the Clerk at 519-688-3009 Ext. 4044.

Name (Nominee):

Street Address (Nominee):

Nominee's Telephone Number:

Nominee's Email Address:

As the Nominator you are required to confirm the Nominee's willingness to be considered for the award.

I confirmed the nominee is willing to be considered for the award.

Name (Nominator):

Nominator's Email Address

Nominator's Telephone Number:

List all of the reasons for why you are nominating this individual for the Town's consideration:

Please attach any documentation you may wish to use to support your nomination. This may include references, letters, etc.

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