2024 Community Award Nomination Form
Thank you for nominating someone for a 2024 CF Canada Community Award. You can also nominate yourself if you wish. If you need to take a break, you can save your nomination and finish it later by clicking any "Save & Continue Later" button below. Please note that you'll need to sign up to use this feature and will be asked to create a password for privacy reasons. You may be asked to create an updated password that is HIPAA compliant.
Your Name (Nominator)
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First Name
Last Name
Your Email
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example@example.com
Your Phone Number
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Please enter a valid phone number.
Please review the Awards summary here to understand the criteria and help guide your submission. For complete details on each award, please click here to visit https://www.cysticfibrosis.ca/get-involved/volunteer/canada-awards
In reviewing the award criteria (above), does the individual, group or company you are nominating meet the criteria?
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Yes
No
Are you nominating an individual, group or a company?
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Individual
Group (including a family or group e.g. Walk team or group that hosts a 3rd party event)
Company (including Service Club, Corporation, Business)
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Nominating an Individual
Name of individual being nominated (Nominee). Note: self nominations are accepted. If you've selected the wrong option, please click on the "back" button at the end of this page to return and make a different selection.
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First Name
Last Name
Email of Nominee
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example@example.com
What province or territory does the nominee live in?
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Please Select
BC
AB
YK/NWT/NU
SK
MB
ON
QC
NB
NS
PEI
NL & Labrador
Does this individual live with Cystic Fibrosis?
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Yes
No
Please confirm the nominee's age at time of nomination
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Which Award are you nominating this individual for?
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Pam Summerhayes Award (for those living with CF)
Eva Markvoort Award (20-35 yrs old)
Youth Impact Award (19 yrs and younger)
Julia - Young Philanthropist Award (35 yrs and younger)
Financial Impact Award
Change Maker of the Year Award
Céline Award
Volunteer Impact Award
Leadership in Advocacy Award
Beyond Limits Award
King Charles III Coronation Medal (SUBMISSIONS NOT ACCEPTED AFTER SEPT. 19)
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Nominating a Group or Family
Please confirm the type of group you are nominating. If you selected the wrong option, click the "back" button at the bottom of this page to return and choose a different one.
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A family
A group (ie Walk team or group of people who organize a 3rd party fundraiser)
What is the name of the group you are nominating?
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for example: Carstar - Calgary Store #23, Kin Club of St. John's, etc
What is the name of the family you are nominating?
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for example: the Franklin family, the Singh-Patel family, etc
Primary Contact Name for Nominee Group:
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First Name
Last Name
Primary Email for nominee group:
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example@example.com
Which Award are you nominating this family for? Awards available for families:
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Financial Impact Award
Mila Mulroney Award (for families directly impacted by CF)
Céline Award
Volunteer Impact Award
Leadership in Advocacy Award
Beyond Limits Award
Is the family directly impacted by Cystic Fibrosis? (meaning a member of their immediate family lives/lived with CF)
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Yes
No
Please describe the family's journey with cystic fibrosis:
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Which Award are you nominating this group for? Awards available for groups:
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Financial Impact Award
Céline Award
Volunteer Impact Award
Leadership in Advocacy Award
Beyond Limits Award
Please describe the group's connection to cystic fibrosis:
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Please add additional family or group member names and/or emails. Use the "Add row" button to add as many people as needed.
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Nominating a Business/Service Club
Please confirm the type of group being nominated. If you've selected the wrong option, please click on the "back" button at the end of this page to return and make a different selection.
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A Service Club
A Business or Corporation
What is the name of the Business or Service Club you are nominating?
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Which Award are you nominating this Service Club/Business for? Awards available for groups:
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Financial Impact Award
National Champion Award
Beyond Limits Award
What is the scope of focus for this business/corporation?
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Local (in 1-2 cities)
Regional
Provincial
National
International
Does the Nominee (business/corporation) have a presence in 3 regions in Canada?
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Yes
No
Please indicate the regions where the Nominee Group has a presence. Choose all that apply.
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Western Canada
Prairies
Northern Canada
Ontario
Québec
Maritimes
Atlantic Canada
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How long has the nominee been involved with CF Canada?
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less than 5 years
5-10 years
more than 10 years
I'm uncertain
Please describe the nominee's contributions to the CF community and/or CF Canada and what makes them exceptional compared to others. Please give as many details as possible to strengthen your nomination
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Please explain how the nominee meets the outlined award criteria. For full award criteria, please visit https://www.cysticfibrosis.ca/get-involved/volunteer/canada-awards
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Why do you feel it's important to recognize this individual/group/corporation now?
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Feel free to upload a supporting document (e.g. news articles, social media posts that highlight the nominee's contributions or successes)
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Is the nominee aware they are being nominated for this award? Should they be selected, we will be asking for their consent to stand as a recipient.
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Yes they are aware
No they are not aware
Before submitting your nomination
Please ensure you have provided as much detail as possible in your submission. Reviewers can only judge based on information provided. Note: the Awards Review Panel may recommend your nomination be considered for a different award category, where fit exists.
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