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Volunteer Achievement Award Nomination Form

Recognizing individuals who make significant, sustained contributions to the community as a volunteer.

Name (Volunteer)

Street Address

Town

Postal Code

Phone Number (Day)

E-mail

Consent of Volunteer Being Nominated

I consent to my name being put forward for consideration for the Volunteer Achievement Award

Name (Nominator)

Street Address

Town

Postal Code

Telephone Number (Day)

E-mail

Declaration of Individual Making the Nomination

I declare that the information provided on this form is correct to the best of my knowledge.

Which category does this nomination belong in?

Art, Culture & Heritage

Civic

Seniors & Youth

Sport, Recreation & Education

Type of Involvement - Describe the nature of the nominee's volunteerism. Which organizations are they involved with?

Type of Achievement - What contributions does the Nominee make? Length of service?

Level of Impact on the Community - How does the community benefit from this Nominee's service?

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

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