T. Roy Adams Humanitarian of the Year Award Nomination Form

Nominee Information

* First Name

* Last Name

* Occupation

* Address

* City/Town

* Postal Code

* Phone xxx-xxx-xxxx

Ext.

* Email

Sponsorship

Nominees will remain eligible for three years. Applications made for this year, the three runners up will automatically be forwarded to the next two years.

This nominee is being sponsored by:

• An organization
• Two individuals (co-sponsors, not related to the nominee)

Nomination Details

Provide a detailed description (approximately 700-1000 words, two typed pages) that highlights the nominee's lifetime commitment to community service and volunteerism.

Provide an explanation as to why you feel the nominee deserves to be recognized with this award?

Supporting Documentation

You may attach additional letters of support to be included in your application.

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email our Access and Privacy Office or call 905-980-6000 ext. 3779.