MY NOMINATION IS FOR:

JUNIOR

VOLUNTEER

SERVICE PROVIDER

A GROUP

A BUSINESS

Please fill in the following section if Junior, Volunteer or Service Provider was selected.

Mr.

Mrs.

Ms.

Miss

First Name

Last Name

Address

City

Postal Code

Daytime

Evening

E-Mail

Please fill in the following section if Group or Business was selected.
Name of Group or Business
Name of Chief Administrator/Executive Officer
Address
Suite/Unit #
City
Postal Code
Phone
Fax #
E-Mail
Website address

NOMINATION SUBMITTED BY:

Name

Organization/Company Name

Address

City

Postal Code

Daytime Phone

Evening Phone

What is your relationship with the nominee?

How long have you known the nominee?

Description (50 - 500 WORDS)

Explain how this is specific to children and their families. Describe all the ways that the community benefits from the nominee’s work. Please list any additional contributions (time, resources, financial). Is this an ongoing commitment? How long has the nominee been actively involved in our community? List nominee’s prior experience and/or additional information. Nominees must reside or do business in the Sudbury and Manitoulin District.

Nomination Form

Champions For Children 2010

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