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Port Hope Civic Awards Nomination Form

Please ensure all informtion submitted is complete an accurate, including spelling of names and addresses. The Civic Awards Committee is only able to use the information provided in the application to determine if the nominee is eligible to receive an award.

If you have questions about the nomination form, please contact civicawards@porthope.ca or call 905-885-7908.

If drafting a nomination on behalf of an organization, please add the name of your nominating organization here.
Please provide your full mailing address (#, street, city, postal code).
Nomination Award Category
Select one category to nominate your nominee.<br><br>*A signature form is required for the nomination of Outstanding Citizen or Outstanding Youth.
NOMINEE Type
Please select the type of nomination you wish to make: Individual, Group/Organization or Individuals within a group.<br>Nomination for individuals: the nominator is required to provide the nominee’s name, complete contact details, and the required information pertaining to the applicable award category for the nominee.<br>For nominations of groups or organizations: indicate the name of the group, complete contact details and provide the required information pertaining to the applicable award category. Only one award and certificate is given out in this circumstance. <br>For nomination individuals within a group/organization: the nominator is required to supply complete contact info, years of service and an explanation of impact for each individual member and submit the nomination as one package. Package can be uploaded in Supporting Documentation at the bottom of this form.
Please enter your nominee's full address (#, street, city, postal code)
Provide as many relevant details as possible to match award criteria. Tell your nominee's story; explain the achievement and it's impacts to the community.
Provide details that build a measurable nomination.

List three (3) qualities that describe your nominee:

Provide descriptors unique to your nominee
Provide descriptors unique to your nominee
Provide descriptors unique to your nominee
Provide documents to support your nomination. Items could include photographs, newspaper articles, certificates of achievement, or letters of support. Supporting documents are not required.
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Located along the shores of Lake Ontario and the Northumberland Hills.

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56 Queen Street.
Port Hope ON L1A 3Z9

Phone 905-885-4544
Fax 905-885-7698

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