Nomination Form-Caregiver Champion Award - CMHA Haliburton, Kawartha, Pine Ridge

Caregiver Champion Award for Family Members

The Caregiver Champion Award for Family Members is presented at the Annual General Meeting, honouring a family member/caregiver who has shown continued support to another family member living with mental illness. Criteria: Family member/caregiver of an individual with lived experience of mental illness who has received services from C.M.H.A. H.K.P.R. Criteria: Please note that the family member/caregiver being nominated does not have to be (past or present) a client of C.M.H.A.

Name of Nominee
First Last
Address of Nominee
Street Address Address Line 2 City Province Postal Code
Nominee's Email Address
Nominee's Phone Number
How has this person supported their family member through adversity?
Please write your response here. Maximum of 500 words.
Does this person know you are submitting their name?
- Yes
- No
Your Name
First Last
Your Address
Street Address Address Line 2 City Province Postal Code
Your Email
Your Phone
How do you know the nominee? (e.g., family member, friend, colleague, etc)
CAPTCHA

Nomination Form–Caregiver Champion Award

Submissions will be accepted until 4:30 p.m. on Monday, June 21st, 2024.

Caregiver Champion Award for Family Members