NATIONAL ETHNIC PRESS AND
MEDIA COUNCIL OF CANADA Conseil
national de la presse et des medias ethniques du Canada Canada’s 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 I understand that that in the event of any fact being found wrong, the award, even if given, shall be withdrawn.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:
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