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of

(printed full title (Mr./Ms./rank) & name of Nominator)

Organization/group or city/province-territory

of

(printed full title (Mr./Ms./rank) & name of Nominee)

Organization/group or city/province-territory

(Signature of Nominator)

Date

Nominator’s e-mail address:

Nominator’s contact number:

(Signature of Nominee)

Date

Title:
 (Mr/Ms/rank/other)

First & last name(s):

City/town of residence:

Province/territory:

E-mail address:

Contact number:

Contributions to search and rescue have been made through service . . .
(mark one or both, as applicable; include affiliation(s) and approximate years of service)

Yrs of service

. . . as a volunteer with:
(incl. all relevant groups)

. . . as an employee of:
(incl. all relevant employers)

1)

Nomination Statement          
State, clearly and succinctly, the core reason why the nominee is being recommended for this award.  Be sure to reference the award category.  Refer to Section 3.0 of the guide as required.

For example, “As a result of his lifelong commitment to the volunteer lifeboat service, including 45 years as a crewmember and 15 years leading the national safety program,  Mr. Brown is hereby nominated for an Award of Excellence for Exemplary Service”.

2)

Detailed description of accomplishment(s)       
Describe in detail, using qualitative or quantitative means, the accomplishment(s) of the nominee.  The accomplishment(s) being described should be related directly to the reason for the award.   Include information on the level of effort invested by the nominee, such as duration and intensity of work done, as/if applicable.

Additional pages may be used as required (not to exceed maximum for the nomination package).

For example:  “Mr. Brown was introduced to the lifeboat service at the age of 18, and rapidly qualified for operations.  For the next 45 years, he served in progressively more responsible roles at a number of units on the coast, acting as coxswain of the busy Humber unit from 1985 to 2006.  During this period, he mobilized the volunteers and the local community to fundraise for a second vessel and a new boathouse, a goal which was realized in 1999 when the “Spirit of Humber” was delivered and commissioned in front of the new facility.  Mr. Brown also contributed at the national level, leading the safety committee from 1992 to . . .” etc.

3)

Impact Assessment
In this section, the impacts the nominee’s achievements have had on search and rescue should be communicated.  Additional pages may be used (not to exceed maximum for the nomination package). 

The following criteria will be used to evaluate the nomination:

1. Significance and relevance of the impact:  How have the nominee’s efforts improved or enhanced search and rescue, or a situation (e.g. crisis) where SAR played a key role?  What opportunities might otherwise have been lost; or challenges left unresolved; or lives/communities adversely affected if the nominee hadn’t made their contribution(s)?  Did the nominee’s contributions directly impact search and rescue, or did they have a more indirect impact?
2. Challenges: Did the nominee face any particular challenges in the course of their work?
3. Extent/magnitude:  Have the nominee’s accomplishments had an impact locally, nationally, and/or internationally?
4. Duration:  Are these positive effects likely to have an impact over the short term, medium term, or long term? 

For example:  “Without Mr. Brown’s unwavering belief in the service provided by his fellow volunteers, and his ability to convince, motivate, and lead others, it is unlikely that the enhancements at Humber would have been realized. Operational capability in the region is now secured well into the future.  Similarly, the safety system his committee implemented, highly unpopular at first, is now considered vital to the service’s national program, and is being used as a model by other jurisdictions . . .”  etc.

Affiliation:
(Group, organization, agency)

Relationship to nominee:
(e.g. colleague, supervisor, subordinate, stakeholder, etc.)

Location:
(e.g. city, province/territory, country)

Contact daytime telephone number / e-mail :

Affiliation:
(Group, organization, agency)

Relationship to nominee:
(e.g. colleague, supervisor, subordinate, stakeholder, etc.)

Location:
(e.g. city, province/territory, country)

Contact daytime telephone number / e-mail:

The total size of this nomination package is:

pages.

Date Modified: 2013-01-21