Canadian Injury Prevention & Safety Promotion Conference
Nomination Form 2011
Please complete one form to accompany your nomination.
Nomination Deadline: September 30, 2011.
My name is (nominator):
Organization:
Address:
City: Province:
Phone: Fax:
I nominate:
(Name of individual, initiative, coalition, community)
for the following award (check one)
Leadership
Innovation
Advocacy
Research
Nominee Contact Information:
Contact Name:
Address:
City: Province:
Phone: Fax:
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Complete nomination packages must include:
Completed nomination form
Nomination letter
Support letter (see below)
If nominee is an initiative or a group of people, this letter must be from someone
external to the group.
If nominee is an individual, this letter must be from an individual external to the
nominee’s organization.
Nomination letters should be no longer than two pages each and a minimum of 12 pt font.
They must include information illustrating how the nominee(s) meets the award criteria
as listed on the Award Descriptions.
REMEMBER: Nominations will be judged on the information contained in the
nomination package. Do not assume that the Selection Committee has knowledge of the
individual, organization and/or initiative that is being nominated. If you feel that
additional information is required for the Selection Committee to fully understand the
nomination, please include additional documentation.
Application packages should be forwarded to:
Canadian Injury Prevention & Safety Promotion Awards
c/o Safe Kids Canada
180 Dundas Street West, Suite 2105
Toronto, Ontario M5G 1Z8
Phone: (416) 813-
Fax: (416) 813-4986
Email: pamela.fuselli@sickkids.ca
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