Nomination Form

To be considered, the nomination form must be received no later than January 31st. Please submit completed forms electronically, or by fax to Suzette Clark at 416-751-7079.

* denotes required information

Nominee

*	Name:
*	District Name and #:
*	Bargaining Unit:
*	Workplace:
*	Full Address:
	Work telephone:
	Home telephone:
	E-mail:

Nominator

*	Name:
*	District Name and #:
*	Bargaining Unit:
*	Workplace:
*	Full Address:
*	Work telephone:
*	Home telephone:
*	E-mail:

Endorsed By

*	Name:
*	District Name and #:
*	Bargaining Unit:
*	Office/Position Held:

Information to Support Nomination

*	Outline how the nominee has shown leadership and activism in building awareness and advocating on women’s equality issues within OSSTF/FEESO, education, women’s movement, labour and/or the local, national or international community.
	Explain what effect these contributions have had in improving equality for women and girls, and enhancing their opportunities for leadership and engagement

Supporting Information

Additional material or letters which support this nomination may be attached for consideration.

Letter attached	(Filetypes allowed: .wpd / .pdf / .doc / .docx / .txt)
	to be sent directly

Letter attached	(Filetypes allowed: .wpd / .pdf / .doc / .docx / .txt)
	to be sent directly

Letter attached	(Filetypes allowed: .wpd / .pdf / .doc / .docx / .txt)
	to be sent directly