Frontenac Access Awards Nomination Form

Nominator Information:

Nominator Name(Required)

First Last

Telephone (Daytime)(Required)

Company or Organization Name (If Applicable)

Date

Nominee Information:

Company or Organization Name (If Applicable)

Name of Nominee

First Last

Address of Nominee

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

Telephone (Daytime)

Email Address of Nominee

Nominators should include sufficient information to give the selection committee an understanding of the contributions made by the nominee, such as information about the projects and biographical information. In the area below, please include the following information: – A description of what the nominee has done to improve the quality of life for persons with disabilities in the County of Frontenac – Information on the value and impact of the nominee’s contribution – Briefly describe the initiative or act of kindness

Please describe what the nominee has done to improve the quality of life for persons with disabilities in the County of Frontenac.

Describe the impact to which the initiative has on developing and delivering interesting and effective awareness about disability and accessibility issues.

Click the “Submit” button at the bottom of this page to complete your nomination.

If you prefer, nominations may alternatively be submitted by mail to the following:

County of Frontenac

2069 Battersea Road

Glenburnie, ON

K0H 1S0

Attention: Jannette Amini, Manager of Legislative Services/Clerk

or via email: jamini@frontenaccounty.ca

Township of North Frontenac 6648 Road 506 Plevna, ON K0H 2M0 Attn: Tara Mieske, Clerk	Township of Central Frontenac 1084 Elizabeth St PO Box 89 Sharbot Lake, ON K0H 2P0 Attn: Cindy Deachman, Deputy Clerk
Township of Sounth Frontenac 4432 George Street PO Box 100 Sydenham, ON K0H 2T0 Attn: James Thompson, Deputy Clerk	Township of Frontenac Islands Box 130, Road 96 Wolfe Island, ON K0H 2Y0 Attn: CAO/Clerk