Community Excellence Nominee

Fill out the form below to nominate an Individual, Business or Organization for the 2019 Awards of Excellence Gala - Community Excellence Award.

First Name*

Last Name*

Email Address*

Phone*

Name of Nominee*

Description of Achievement - Briefly describe why you think this individual/company deserves this award*

How does/has this person/company demonstrate a notable contribution to the quality of life in the Brockville communty?*

Does this person/company volunteer their time and/or financial support to those activities that enrich the community? Can you provide some examples?*

Does this person/company promote a culture that puts an emphasis on community involvement? Can you provide an example?*

Please provide examples of how this person/company partners and/or supports with not-for-profit organizations, charities or other community efforts

Is Nominee aware of this nomination?*

YesNo

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Nomination Submitted By

*

I acknowledge that I have read and understand that my nomination qualifies for the category criteria selected.

First Name*

Last Name*

Phone*

Email*