Junior Citizen of the Year – Nomination Form

Use the form below to submit a nominee. All nomination forms will be held in strict confidence and will only be provided to the selection committee.

You can also download the paper version of the 2022 Junior Citizen of the Year nomination form here.

    Name of Nominee

    Date of birth (mm/dd/yyyy) (Cannot be older than 18 as of March 31, 2022)

    Address (complete mailing address required)

    City/Town

    Postal Code

    Telephone Number

    Nominee's Parent or Guardian

    Parent or Guardian's Phone Number

    Name of Nominator

    Address (complete mailing address required)

    City/Town

    Postal Code

    Telephone Number

    Relationship with Nominee

    Name of Nominee's School

    How did you hear about the Junior Citizen of the Year Program?

    Describe how the nominee contributes to their community and school

    Please describe the challenges this nominee has had to overcome (physical, emotional or environmental).

    Describe how the nominee has inspired others

    Describe how this nominee supports and helps at home.

    Add further comments or additional supporting material that highlight the reasons why the nominee should be considered for the award.