Caring Canadian Award

The Governor General's Caring Canadian Award -- Nomination Form

(This document is confidential once completed.)

The person I am nominating is

Mr. / Mrs. / Ms. / Miss (Please circle)

Other title:

Language: [  ] English     [  ] French
Mailing address
 
 
 
Postal code

Telephone no. during the day
(    )

Other telephone no.
(    )
Date of birth
Fax no.
(    )
Citizenship
E-mail address
 
Date naturalized

Attach your reasons for making this nomination.

Please provide an up-to-date biographical sketch of the nominee, including dates of active participation in organizations and any awards/honours received.

Nominator

My name is Mr. / Mrs. / Ms. / Miss

Other title:
 

Mailing address
 
 
 
 
Postal Code
Telephone no. during the day
(    )
Fax no.
(    )
E-mail address
 
Signature
 
Date

Please provide letters of support or the names of three people who can support this nomination.

The following are the names of people who could support this nomination
1. Name, title, address, postal code
Mr. / Mrs. / Ms. / Miss
Other title
 
 
 
 
 
[ ] English   [ ] French
2. Name, title, address, postal code
Mr. / Mrs. / Ms. / Miss
Other title
 
 
 
 
 
[ ] English   [ ] French
3. Name, title, address, postal code
Mr. / Mrs. / Ms. / Miss
Other title
 
 
 
 
[ ] English   [ ] French

Send the nomination form with supporting material to (no postage required if mailed in Canada):

The Governor General of Canada
Attention: The Chancellery of Honours
Rideau Hall
1 Sussex Drive
Ottawa, ON  K1A 0A1

For more information, please call: 1-800-465-6890