Outstanding Service Award Nomination Form

Outstanding Service Award

Personal Information of nominee

Nominee's full name *

Address

City

Province

Postal Code

Telephone

Discipline

The nominee has been employed or provided service to CAMRT for the past 10 years:

Yes

Submitted by

Name *

Member no.

Telephone during the day

Your Email *

Do you give CAMRT permission to disclose your name as nominator to the nominee if requested?

Yes

Selection Criteria

Please answer the following questions which are based on established judging criteria for nomination of an individual for the Outstanding Service Award. Limit response to each question to 250 words.

What has been the nominee’s significant contribution(s) that have improved or changed the direction of service/practice enhancing the credibility of the association/profession?

How has the nominee influenced and mentored others to seek higher achievement within the association/profession?

What has been done/ accomplished by the nominee that speaks to his/her high level of commitment and dedication?

How is the nominee appreciated as a team member and/or leader?

Are there other noteworthy accomplishments by this nominee that shows evidence the nominee is regarded as a steward or champion of the profession in their province or nationally? Limit response to 400 words.

If available, also include a copy of the nominee's curriculum vitae (Word or PDF format).

Attachment

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