1922 Award Nomination Form

NOMINATOR

Nominator Name *

First

Last

Nominator MTS Number

Nominator Local Association

Nominator Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nominator Primary Telephone *

Nominator Email *

Declaration of Nominator. I confirm that: *

I have carefully read the eligibility criteria and nomination guidelines for this award.
I am an eligible nominator as described in the nomination guidelines.
The nominee meets the eligibility criteria.
I agree to keep the results confidential until the nominee is notified.
I am unaware of any circumstances that would preclude this nominee from qualifying for this award.
The statements in my nomination are complete and accurate, to the best of my knowledge.

Date *

NOMINEE

Nominee Name *

First

Last

Nominee MTS Number

Nominee Local Association

Nominee Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nominee Primary Telephone *

Nominee Email *

Declaration of Nominee. I confirm that: *

I have carefully read the eligibility criteria and nomination guidelines for this award.
I am an eligible nominee as described in the nomination guidelines.
I agree to keep the results confidential until it is public.
If I am the successful recipient, I will provide the Society with photos and bios as requested.
If I am the successful recipient, I will attend the Annual General Meeting of Provincial Council in May 2023 to accept my award (expenses paid).
The statements in this nomination are complete and accurate, to the best of my knowledge.

Date *

NOMINATION STATEMENT

Describe the nominee’s leadership, commitment, and fortitude in service of union values and priorities. Specify whether they have occurred over time or as a single action. Explain how the nominee has influenced positive, sustained change for current and future union members. Union values and priorities may include, but are not limited to: Solidarity (coordinating communication, strategy, activism among members and allies to advance the work), Democracy (using voice and action to advance the mission of unionism) and Participation (raising the profile of union, labour, justice, and public service policies and issues by being informed, sharing information, leading within the union).

Statement of Nomination *

1200 word count max.

LETTERS OF SUPPORT (3 max.)

Optional letters of support may be provided by up to three people who are not the nominator. Letter(s) of support must include contact information of the writer(s).

File Upload (Letter #1)

Upload Adobe PDF or MS Word DOC files only.

File Upload (Letter #2)

Upload Adobe PDF or MS Word DOC files only.

File Upload (Letter #3)

Upload Adobe PDF or MS Word DOC files only.