Nomination Form

1. Name and contact information of nominee


First Name
Last Name
Address
City
Province and Postal Code
Telephone (B)
Telephone (Cell)
Email
2. Recent work history (summary) of nominee. (Suggested 250 - 300 words. If possible, a CV of the nominee should be included as part of the nomination package).
3. The Award is awarded on the basis of demonstrated leadership potential within the public service, demonstrated ideals and values of public administration, and demonstrated ability and potential to continue and constantly improve upon the sound work of public administration and public servants. Indicate clearly and precisely the nominee's activity and contribution in the above mentioned criteria. Attach any other supporting material. (Suggested words : 1500)
4. Include at least one letter of support for the nominee of this award (maximum 3 letters). Letter(s) should ideally be from supervisors or other public servants familiar with the nominee's work within the public service. Letters should be from persons other than the nominator.
Name of Nominator
Address
City, Province and Postal Code
Telephone (B)
Telephone (Cell)
Email
Date of Submission

Please note
The award is made solely on the basis of information provided on this form.
The onus is on the nominator to state exactly how the nominee meets the award criteria.
The form is confidential once completed and submitted.

Deadline for receipt of nomination is June 24.

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