Government of Ontario: Ministry of Citizenship and Immigration

Senior of the Year Award

Nominating Municipality/Township

Print the municipality name in full as this will be transcribed onto the recipient’s certificate.

Contact Name

Address City/Town
Province Postal code

Telephone Fax

Recipient

Name of Recipient (must be 65 years of age or older)

Tell us briefly about your recipient:

Address City/Town
Province Postal code

Telephone Fax

Nomination forms may be submitted at any time. The deadline is April 30 of each year. All nominations received after this date will be considered for the following year.

Mail or Fax to:
Ontario Honours and Awards Secretariat
Ontario Ministry of Citizenship and Immigration
400 University Avenue, 4^th Floor
Toronto ON M7A 2R9
Tel.: 416 314–7526 Fax: 416 314–6050

Personal information on this form is collected under the authority of the Ministry of Citizenship and Culture Act, R.S.O. 1990, cM.18, s.4 and will be used to determine eligibility and notify recipients of the Senior of the Year Award. For further information, please contact the Manager, Ontario Honours and Awards Secretariat, tel. 416 314–6608.
For service in French, telephone 416 314–7529 or 416 212–3196.