EmailMe Form - Strathmore Community Champions Nomination Form

Contact Information

Please enter your contact information below

Name *

First Last

Phone

### - ### - ####

Email *

Confirm

Nomination Information

Please fill out the nominee's information below

Is this a group or individual nomination? *

Group

Individual

Select one

Is this a self-nomination? *

Yes

No

What is the nominee a champion of?
(eg. If the nominee has organized a food drive, they would fit into the Community Donations category)

Community Spirit

Community Donations

Community Volunteerism

Community Acts of Service

Community Leadership & Initiative

Which of these 5 categories does the nominee's actions fit?

Describe their actions to support Strathmore during the COVID-19 emergency? *

Help us understand this champion by telling us how they have helped Strathmore

How many people are involved?

Let us know how many people are helping!

Are there partners involved?

Yes

No

Who are these partners?

Is it part of a regional/provincial/national initiative?

Yes

No

Which one(s)?

Hold ctrl to select multiple ones.

How long has this initiative been taking place?

Why did they choose to get involved?

What has been the reaction from the people they're trying to help?

Will this service/group/etc. continue after COVID-19?

Yes

No

Not Sure

Nominee Contact Information

Please fill out the nominee's contact information below

Name of group/individual

First Last

Email

Confirm Email Address

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number

### - ### - ####

Main number they can be reached at

Alternate Phone Number

### - ### - ####

Alt. number (cell, home, etc.)

Upload files

Feel free to upload pictures, videos, or anything that shows this nominee exemplifying what it means to be Strathmore Strong!