Nomination Form-Distinguished Service Award - CMHA - Haliburton, Kawartha, Pine Ridge

Submissions will be accepted until 4:30 p.m. on Friday, June 14th, 2019.

Distinguished Service Award

The Distinguished Service Award is presented at the Annual General Meeting. Each year, the Canadian Mental Health Association Haliburton, Kawartha, Pine Ridge ( C.M.H.A. H.K.P.R.) acknowledges the significant contribution volunteers make to our agency and the work we do by recognizing deserving individuals for their exemplary effort. The Distinguished Service Awards are awarded by CMHA Ontario in the form of certificates. Two Distinguished Service Awards will be presented. The following criteria are used in choosing outstanding volunteers for this award: Responsiveness to the needs of CMHA; Impact of their contributions to the organization/cause; Diversity of involvement; Length of service; Level of responsibility; Other special qualities which illustrate effort, commitment and results.

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
Based on the above criteria, what is it about this nominee that makes them deserving of a Distinguished Service Award?
Please write your response here. Maximum of 500 words.
What impact has the volunteer had upon your branch or your community?
Please write your response here. Maximum of 500 words.
Additional comments:
Please write your response here. Maximum of 500 words.
Your Name
First Last
Your Email
Your Phone
Your role at CMHA HKPR

Nomination Form–Distinguished Service Award

Submissions will be accepted until 4:30 p.m. on Friday, June 14th, 2019.

Distinguished Service Award

Peterborough Office

Kawartha Lakes Office

Administrative Office