Awards of Excellence Application - Business

ORGANIZATION / BUSINESS / INDUSTRY NOMINATION FORM

Personal information on this form is collected under the auhority 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

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

Phone

Nomination Submitted By

Name

First

Last

Name of Organization (if applicable)

Position (if applicable)

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

Phone

Is the nominee aware of this nomination?

Yes
No

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 the information provided in the nomination package. It is therefore important that all materials listed below be complete.

Please indicate the category for which the business/organization is being nominated.

of being your

Please specify the "other" category for which the business/organization is being nominated.

Contribution Description

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 at least two written letters of support.

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Letters should be current and from persons who can attest to the value and impact of the contributions of the nominee.

Additional Material

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

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

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