Order of Gabriel Dumont Nomination Form

NOMINATION FORM

I would like to nominate the following person to the Order of Gabriel Dumont:

Last (Family) Name*

First (Given) Name*

Permanent Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone Number*

Email*

Enter Email

Confirm Email

Home Community*

Nominator Contact Information

Nominations made by parents, caregivers, siblings, children, spouses, partners, or of close relations of the nominee will not be considered. Gabriel Dumont Institute staff, faculty, sub-contractors, and current board members are not eligible to receive an Order of Gabriel Dumont award. Past Order of Gabriel Dumont recipients may not be awarded the Order of Gabriel Dumont in the same category twice.

Please provide some detail about yourself:

Nominator's Last (Family) Name*

Nominator's First (Given) Name*

Nominator's Permanent Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Nominator's Phone Number*

Nominator's Email*

Enter Email

Confirm Email

Nominator's Home Community*

Nomination reasons*

My reasons for making this nomination are: (This should be a statement of why you think your nominee should be a recipient. Be specific about your nominee’s achievements and contributions to the Métis community, including timelines/how long the person has been involved in their work/efforts on behalf of the Métis, and other notable activities—cover the five Ws. Please limit your nomination to a maximum of 500 words.

Letters of Support

Please attach to the nomination at least two letters of support. Nominations received without two letters of support will be deemed incomplete

You can submit up to a maximum of 5 documents

File*

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Terms and Conditions*

The Gabriel Dumont Institute (GDI) reserves the right to determine the level at which the successful nominations will be honoured. Incomplete nomination forms will not be considered. Late nomination forms will not be considered. Nominations made by parents, caregivers, siblings, children, spouses, partners, or of close relations of the nominee will not be considered. GDI staff, faculty, sub-contractors, and current board members are not eligible to receive an Order of Gabriel Dumont award. Past Order of Gabriel Dumont recipients may not be awarded the Order of Gabriel Dumont in the same category twice. Nomination packages become the property of GDI and will not be returned. By signing I agree to the terms and conditions and agree that the information provided may be used to promote the Order of Gabriel Dumont awards and/or during the awards ceremony itself.

I agree

THE ORDER OF GABRIEL DUMONT

NOMINATION FORM

Nominator Contact Information

Letters of Support

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