Required fields are marked with asterisks (*)

2023 Lanark County Awards of Excellence

ORGANIZATION / BUSINESS / INDUSTRY NOMINATION FORM

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used to determine eligibility and notify recipients of the Lanark County Awards of Excellence.

For additional information, please contact Megan Beson, Deputy Clerk by email at mbeson@lanarkcounty.ca or by phone at 613-267-4200 ext. 1102.

Please complete the form in full.

Organization / Business / Industry Being Nominated

Name of Organization / Business / Industry

Contact Person

Mailing Address

Town

Province

Postal Code

Name of Municipality

Telephone Number

Nomination Submitted By

First Name

Last Name

Name of Organization (if applicable)

Position (if applicable)

Mailing Address

City/Town

Province

Postal Code

Telephone

Is the nominee aware of this nomination?

Yes

In addition to completing the nomination form, please provide a brief description of your nominee's activities and the contribution they have made. Please note that the selection of award recipients is based solely on information provided in the nomination package. It is therefore important that all materials listed below be complete.

Please indicate the category for which the individual is being nominated.

Description of Contribution

Describe the contribution the nominee made to the County in detail, including any background or historical information related to the contribution.

Describe what made this a significant and/or extraordinary contribution to the County for your nominee, including any extraordinary circumstances or challenges the nominee faced.

Indicate how long you have known the nominee.

Indicate when the contribution was initiated and completed.

Two Letters of Support

Please include two written letters of support. Letters should be current and from persons who can attest to the value and impact of the contributions of the nominee.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Additional Material (Optional)

List any additional material provided to support this nomination. For example, publications, media stories, etc.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif