Civic Award Nomination Form:


Fields marked with * are mandatory



Nomination Form for 2017 Civic Award

Please ensure all information submitted is complete and 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 & qualified to receive award. If you have questions about the nomination form, please contact civicawards@porthope.ca or call 905-885-7908.

* A signature form is required for the nomination of Outstanding Citizen or Outstanding Youth. You may download the form here: www.porthope.ca/civic-awards and submit the completed form through this online submission form or by emailing it to civicawards@porthope.ca



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. For nominations of groups or organizations: indicate the name of the group/team, complete contact details and provide required information pertaining to applicable award category.  Only one award and certificate is given out in this circumstance.If nominating 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, or emailed to civicawards@porthope.ca.


Nominee Address (number, street, city, postal code)










List your first quality that describes your nominee.





You may upload supporting documentation (letters of recommendation, etc.) if desired (not required)



You may download the required signature forms here: www.porthope.ca/civic-awards