City of Elliot Lake - Civic Awards Nomination Form

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NOMINATOR

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Please complete the following with your information.

First name *

Last name *

Email *

Mobile

Address

City

State/Province

Zip/Postal code

NOMINEE

Please complete the following with the information of the person you are nominating.

Full Name *

How long has this person lived in Elliot Lake *

Is the person deceased? *

Yes No x Clear

When did this person pass away? *

Please describe the personal character of the Nominee and provide comments regarding their reputation and dedication to the community. *

CIVIC-MINDED ACTIVITIES

Please tell us about the type of civic-minded activities that the Nominee has completed, for which organization or group, and for how many years they have been participating in these activities. If there is not enough room, you may upload more information later on in the questionnaire. You must answer for at least one organization or group.

Activity Description *

Organization Name *

Longevity of Service *

Would you like to include another activity? *

Yes No x Clear

Activity Description *

Organization Name *

Longevity of Service *

Would yo like to include another activity? *

Yes No x Clear

Activity Description *

Organization Name *

Longevity of Service *

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TIME AND DEDICATION *

Help us understand the amount of time and effort that the Nominee puts into their service to the community. Describe the amount of time that is dedicated to the organizations and activities, the intensity of the dedication, and how consistent the Nominee has been in providing service.

MOTIVATION *

It is helpful to understand the motivation behind the Nominee's service to the community. Please explain why you believe the Nominee has participated in the aforementioned activities. What benefits does the Nominee receive for these activities?

Does the Nominee receive any compensation for their volunteer activities? *

Yes No x Clear

Please describe the compensation. *

OVERALL VALUE *

Please describe the value of the Nominee's activities to the community, organization, or group.

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