NATIONAL ETHNIC PRESS AND
MEDIA COUNCIL OF CANADA
Conseil
national de la presse et des medias ethniques du Canada
Canadas Other Voices
Awards
Nomination Form
Part
A
Name
of Nominator
..
Community
Address
City
.
Province
. Postal Code
Phone
..
Fax
Email
.
Member
of NEPMCC since
..
Part
B
Details
of Nominee
Name
of Nominee
Community
..
.
Category
for which recommended
.
Address
City
Province
Postal
Code
Phone
..
Fax
Email
..
State
in five lines why you are recommending the person (documentary proof may
be
attached)
..
..
.
..................
..
..
Give
three specific examples of above statement:
a
..
b
..
.
c
..
How
is his work relevant for the award (mention in 3
lines)
.
..
Names
and contact details of three other independent persons to whom the
reference can be made)
1
.
..
2
..
3
..
I (name of Nominator) do hereby affirm that the
facts stated above are correct and also that I have
no personal relationship with the nominee.
I
also declare that I am member of the Council in good standing.
I
also confirm that the nominee has not been convicted of any offence by any
court of law.
I understand that that in the event of any fact being found wrong, the award, even if given,
shall be withdrawn.
Signatures
of the Nominator
Place
.
Date
I ( Name of Nominee) do hereby affirm that I shall, if
accepted, accept the award and shall be present
personally at the award ceremony.
I
also confirm that I have no relationship with the nominator.
I also confirm that I have not been convicted of any offence by any court of law and no
criminal case is pending against me in any court.
I understand that that in the event of any fact being found wrong, the award, even if given,
shall be withdrawn.
Signatures
of the Nominee
Place
.
Date
.
Note:
-
Incomplete form in any way shall be rejected without any further reference. Each item must be filled in.
-
Submission of nomination does not mean acceptance by the award committee or automatic award.
-
The decision of the Award committee is final and binding and no communication shall be entertained.
-
the complete form with necessary documents must be submitted to the Chair of the Award committee
-
before the final date.
