Award Nomination: Online Submission

 
 

I Would Like to Nominate:

 
Nominee's Name *
Nominee's Name
Nominee's Mailing Address *
Nominee's Mailing Address
Best Phone Number To Reach (Nominee) *
Best Phone Number To Reach (Nominee)
Please describe in 500 words or less the characteristics of the nominee as they pertain to the Award criteria and provide details on how she/he has demonstrated attributes and qualities that align with the values and principles for which Margaret Trudeau Mental Health Advocacy Award was created. Consider the answers to the following questions when composing your nomination letter: 1. Is the nominee an agent of change? In what ways has the nominee advocated for, and succeeded in producing significant, transformative changes to mental health issues? 2. How has the nominee demonstrated personal commitment and leadership to address concerns about mental health, particularly for women? 3. How has the nominee been influential in communicating and sharing knowledge with others, within the mental health field, and in the larger community?
Nominator's Name *
Nominator's Name
Nominator's Mailing Address *
Nominator's Mailing Address
Best Phone Number To Reach (Nominator) *
Best Phone Number To Reach (Nominator)
Signature *
By clicking on the 'submit' button below, I CERTIFY that all statements and information provided in this Nomination Form are true, complete and correct to the best of my knowledge and belief, and made in good faith. I understand that statements or information provided on this form are subject to verification and I agree to present any other supporting documents or information when so requested and names, addresses, and phone numbers (if required) of officials or other individuals who can substantiate the qualifications described above. I also understand that intentional misstatements or falsification may result in disciplinary action.
Date *
Date