proudly presents
New Pioneers Awards
"Celebration of Diversity"
On-line Nominee Form
for Science and Technology Award
sponsored by
Complete this form only if you have been nominated.
Information about you, the Nominee:
Name:
Mailing Address:
City:
Postal Code:
Telephone (work):
Telephone (home):
Email address
Information about your Nominator:
Name:
Mailing Address:
City:
Postal Code:
Telephone (work):
Telephone (home):
Email address
You are being nominated for which category?
Which Category?
Arts
Community Service
Entrepreneurship
Science & Technology
Skills for Change Graduate
Youth
BARRIERS
Please list any difficulties that you had to
overcome in the process of settling in Canada:
ACHIEVEMENTS
Describe your achievements in the
category for which you have been nominated including any
recognitions and awards that you have received.
You will be
asked to verify this information:
COMMUNITY INVOLVEMENT
Describe any other activities that demonstrate your
involvement in your community:
