Thérèse Casgrain Volunteer Award - Nomination Form

Candidate

Surname
Given Name(s)
Date of Birth                            Gender
Present Occupation

Complete Address

Telephone Number

Sponsors

A candidate for the Thérèse Casgrain Volunteer Award may be sponsored by an organization, or three individuals – a sponsor and two co-sponsors not related to the candidate.

Organization
Complete Address

Telephone Number
Name of Contact Person

Signature

Individuals

1. Sponsor (Contact Person)
Surname
Given Name(s)
Complete Address

Telephone Number
Signature

2. Co-Sponsor
Surname
Given Name(s)
Complete Address

Telephone Number
Signature

3. Co-Sponsor
Surname
Given Name(s)
Complete Address

Telephone Number
Signature

Submit this form with supporting documents to:

Thérèse Casgrain Volunteer Award Secretariat
Social Development Canada
140 Promenade du Portage
Phase IV, 5th Floor
Gatineau, QC K1A 0J9

Note: Supporting documentation must be submitted on 8.5” X 11” sheets. Nominations must be submitted in their entirety and must not exceed 50 pages. Additional enclosures such as cassettes, videotapes, diskettes and CD’s will not be reviewed.

Please refer to the guide to nominations for more information.