AWARD OF EXCELLENCE
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MENTORING
NOMINATION FORM
DEADLINE FOR NOMINATIONS: 4:00PM Pacific Time, August 31, 2011.
The nominee for the Mentoring Award of Excellence is an individual who has
provided guidance and support to youth through a long-term, consistent
commitment to them. This individual is a trusted, adult friend who has provided a
mix of support and challenge by involving youth in their community and enriching
their lives at the same time.
Nominations may only be made by people between the ages of 12 and 24 years.
Full Name of Nominee:
Title: Organization:
Address:
City: B.C. Postal Code/Zip:
Telephone: Fax:
Email:
Full Name of Nominator:
Age: Organization:
Address:
City: B.C. Postal Code/Zip:
Telephone: Fax:
Email:
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Profile of the Nominee
Please use point form to answer the following questions (max. ½ page per
question) about your nominee. Additional information of up to 6 pages may also
be submitted as outlined under Supporting Documentation.
How has this individual inspired and challenged you in your life?
How has this individual made a difference to you in your attitude towards
any of the following: community, volunteering, school, leadership,
employment , arts & culture or sport?
What things does this individual do or what activities has he or she
engaged you in that makes him or her a great mentor?
How has this individual supported you and made you believe in yourself
and your capabilities?
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How has this individual helped you grow and made a difference in your
life?
How many years has the individual or organization been working with B.C.
children, youth and their families? If he or she has had multiple roles,
please provide details including the time spent in each position.
How is the nominee funded?
Please tell us a little bit about yourself.
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Supporting Documentation:
Please include the following supporting documentation up to a maximum of 6
pages: *Note this includes the letters of support.
Brief summary overview of why you think the nominee should be
considered for the Mentoring Award of Excellence.
3 Letters of Support on behalf of the nominee from individuals other than
the nominator.
Any additional relevant information
Important Detail
You must make sure that the nominee has been informed of the nomination and
consents to be considered for the Mentoring Award of Excellence. Please
check here to indicate this has been done.
Signature of Nominator: Date:
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For queries, contact:
Carla Wormald at 250-356-7713 or Carla.Wormald@rcybc.ca
Submission Instructions:
MAIL-
Nomination packages must be clearly marked with “Nomination: Representative’s
Awards of Excellence” on the outside and should be mailed to:
Representative for Children and Youth
PO Box 9207 Stn Prov Govt
Victoria, B.C. V8W 9J1
COURIER-
Nomination packages must be clearly marked with “Nomination: Representative’s
Awards of Excellence” on the outside and should be couriered to:
Representative for Children and Youth
201 – 546 Yates Street
Victoria, B.C. V8W-1K8
EMAIL-
Nomination packages sent electronically must have “Nomination:
Representative’s Awards of Excellence” in the subject line.
Please include all nomination documents in one email to
Carla.Wormald@rcybc.ca.
IMPORTANT NOTE: The Representative reserves the right not to make an
award in each category.
DEADLINE FOR NOMINATIONS: 4:00PM Pacific Time, August 31, 2011
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