Date: Sunday, May 19, 2024

*Please indicate for which award you are nominating?

- Select - Honorary Membership Award of Merit Andre Lecuyer Award Bob Brooks Award Comité des services en langue française Award of Merit Communication Award James Forster Human Rights Award Jennifer MacLean Award John MacNeil Award Kelly Ann MacKenzie Award Nancy Warrener Award Norm Snyder Award Political Action Award in honour of Wendell Fulton and Larry French Liz Barkely Status of Women Award Environmental Award - Sage (bronze) – The District or Bargaining Unit that has completed at least eight (8) of the objectives from any category in the Small Steps to a Greener Union Report Environmental Award - Forest (silver) – The District or bargaining unit that has completed at least sixteen (16) of the objectives from three (3) different categories in the Small Steps to a Greener Union report Environmental Award - Emerald (gold) – The District or Bargaining Unit that has completed thirty-two (32) or more objectives from a minimum of nine (9) categories in the Small Steps to a Greener Union report Environmental Award - Individual Award Racial Justice Agent of Change Award Solidarity Award

*Are you nominating an Individual?

Yes No [ Nominating Individual ] is required.

*Are you nominating a Group?

Yes No [ Nominating Individual ] is required.

*Name of Candidate

[ Name of Candidate ] is required.

*District Name and #

- Select - 01 Ontario North East District 02 Algoma District 03 Rainbow District 04 Near North District 05A Northern Shield District 05B Rainy River District 06A Thunder Bay District 06B Superior-North District 07 Bluewater District 08 Avon Maitland District 09 Greater Essex District 10 Lambton Kent District 11 Thames Valley District 12 Toronto District 13 Durham District 14 Kawartha Pine Ridge District 15 Trillium Lakelands District 16 York Region District 17 Simcoe District 18 Upper Grand District 19 Peel District 20 Halton District 21 Hamilton-Wentworth District 22 Niagara District 23 Grand Erie District 24 Waterloo District 25 Ottawa-Carleton District 26 Upper-Canada District 27 Limestone District 28 Renfrew District 29 Hastings-Prince Edward District 30 PSAT District 31 Franco-Nord Ontarien District 32 Centre-Sud-Ouest de l'Ontario District 33 District de l'Est 34 Independent Educational Programs District 35 Universities and Colleges District [ District Name and No. ] is required.

*Bargaining Unit	- Select - Teacher Occasional PSSP Education Support Staff University Other [ Bargaining Unit ] is required
	If other, please specify

*Workplace	[ Work Place ] is required.
*Address	[ Address ] is required
*City/Town	[ City ] is required	*Postal Code [ Postal Code ] is required

*Phone Number

[ Phone Number ] is required

*Email

[ Email ] is required. Please enter a valid [ E-mail ]

*Name of Nominator

[ Name of Nominator] is required.

*District Name and #

- Select - 01 Ontario North East District 02 Algoma District 03 Rainbow District 04 Near North District 05A Northern Shield District 05B Rainy River District 06A Thunder Bay District 06B Superior-North District 07 Bluewater District 08 Avon Maitland District 09 Greater Essex District 10 Lambton Kent District 11 Thames Valley District 12 Toronto District 13 Durham District 14 Kawartha Pine Ridge District 15 Trillium Lakelands District 16 York Region District 17 Simcoe District 18 Upper Grand District 19 Peel District 20 Halton District 21 Hamilton-Wentworth District 22 Niagara District 23 Grand Erie District 24 Waterloo District 25 Ottawa-Carleton District 26 Upper-Canada District 27 Limestone District 28 Renfrew District 29 Hastings-Prince Edward District 30 PSAT District 31 Franco-Nord Ontarien District 32 Centre-Sud-Ouest de l'Ontario District 33 District de l'Est 34 Independent Educational Programs District 35 Universities and Colleges District [ District Name and No. ] is required.

*Bargaining Unit	- Select - Teacher Occasional PSSP Education Support Staff University Other [ Bargaining Unit ] is required
	If other, please specify

*Email

[ E-mail ] is required Please enter a valid [ E-mail ]

*Telephone Number

[ Phone Number ] is required.

*Please provide examples which support the specified criteria for this award or summarize, with evidence, the work of the individual and group

[ Provide examples ... ] is required.

*Please indicate specific roles and length of service in each category related to the specific field for which the award is meant. For example, if the application is for an Educational Services award, you may wish to include local, district or provincial involvement in Educational Services. If the application is for an Environment award, you may wish to include community activities relating to the award

[ Indicate specific roles ... ] is required.

*Indicate other activities, which may be relevant to the criteria of this award. For example, if this is a Protective Services Committee award, you may wish to specify which leadership role the candidate has provided in the area of member protection

[ Indicate other activities ... ] is required.

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