Collection Notice: Personal information collected on this form is collected in accordance with Section 10(1) of the Municipal Act,

S.O. 2011, c.25 and will be used to contact nominators should

additional information be required; to notify nominees; and, to notify the public of the list of nominees received for the City of Brantford Environmental Recognition Award. Please note that the
names of all nominees will be made public. The disclosure of all other personal information collected on this form will be done in accordance with the provisions of the Municipal Freedom of
Information and Protection of Privacy Act. Should you have questions regarding the collection, use and disclosure of this personal information, please contact the Deputy Clerk/Manager,
Legislative Services Division at Brantford City Hall, 100 Wellington Square, Brantford, N3T 2M3 or by telephone at (519) 759-4150 during regular business hours.
City of Brantford
Environmental Recognition Award
Nomination Form 2014

In April 2014, the City of Brantford will present Environmental Recognition Awards in a variety of categories. More
information about the awards and the categories is available at www.brantford.ca/environmentawards.

Deadline for nominations is Thursday, February 20, 2014.


Nominee Information
Category: Lifetime Achievement Green Non-profit Green Business Greenest Family
(Choose One) Volunteer Young People - Elementary Age Young People - Secondary Age
Water/Energy Efficiency Award
Name:
Address:
Telephone: Fax:
Email:

Summary of Achievement (provide two or three short sentences in each section)
a) Describe activity, project or record of achievement. Please include when and where the activities took place, number
of participants (if applicable) and other relevant highlights.


b) What makes the accomplishment(s) special? Who benefits and how did this improve the environment in Brantford
and its surrounding communities?

Supporting Material (Optional): Please attach photographs, articles or other materials that support the nomination.

Nominator Information
Name:
Address:
Telephone: Fax:
Email:

Send completed form to the attention of Laurie Schunk:
email: epac@brantford.ca fax: 519-759-7840 mail: City Hall, P.O. Box 818, Brantford, Ontario