30 for 30 - Community Leadership Recognition

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Informations générales

Please select the statement that applies to you

Name

Email

Organization or group name

Representative's name

Representative's email

Which sector(s) and/or demographic(s) does your organization/group represent?

Health and Social Services

Education

Arts and Culture

Literacy

Media

Economic Development

Heritage

Justice

Seniors

Youth

LGBTQ+

Women

BIPOC

Other

Which region(s) does your organization/group serve?

Prénom

Nom

Courriel

Region

Please identify

Age

Nominee Leadership Details

Supporting Nominator

I confirm that the supporting nominator named above is aware that this nomination is being submitted and corroborates all details described therein.

Please provide a brief biography of the nominee.

If your nominee is selected for the recognition, the biography will be used for promotional purposes.

Nominee Biography