Nomination Form

Any program, corporation, non-governmental organization or individual helping to combat ageism and stigma, to highlight and promote the strengths associated with aging and the potential and value of older adults in our society. Seniors' mental health teams, programs and individuals can all be nominated. Priority will be given to nominees in the healthcare, continuing care and not-for-profit sectors.
 
Nominee Qualities:
Through innovative and unique programming/service/advocacy
  • Helps combat ageism and stigma
  • Highlights and promotes the strengths associated with aging
  • Highlights the potential and value of older adults in our society
  • Addresses diversity/is inclusive
  • Engages older adults
  • Is visionary and inspiring
  • Works collaboratively with other champions/partners
  • Addresses a priority in the community
  • Creates sustainable initiatives that will have a lasting impact
  • Meets award priority as a nominee in the healthcare, continuing care and not-for-profit sectors

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* 1. Name of Nominator

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* 2. E-mail of Nominator

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* 3. Phone number of Nominator

PLEASE TELL US ABOUT YOUR NOMINEE

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* 4. Nominee Name

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* 5. Is the Nominee...

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* 6. Contact Name of Nominee

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* 7. E-mail of Nominee

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* 8. Phone number of Nominee

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* 9. What area of the country does the Nominee serve?

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* 10. Please tell us about the Nominee and how they meet the award qualities. (maximum 500 words)

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* 11. Your nomination can include statements made by older adults or their caregivers who have been positively impacted by the work of the nominee.  Please feel free to upload a document that includes these statements.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Your nomination can also include collaborating material such as formal program evaluations, program descriptions, pamphlets and/or client reviews of programs and services.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
Announcement and Recognition
The Award recipients will be selected over the summer and will be contacted by the end of August.  We will announce the recipients at the CAGP-CCSMH Annual Scientific Meeting in September.  If the recipient plans to attend the ASM, we can present the award live.  Following the ASM, the successful individual(s) and/or team(s) will be profiled in the CAGP newsletter and the CCSMH e-newsletter, website and social media.
Thank you for taking the time to make a nomination. 
It is so important for Canadians to learn about the great work being done
to promote the mental health of older adults!

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