Nomination Form | Canadian Agricultural Hall of Fame Association

Page 1

Nominator:

Name
First & Last Name & Association if applicable

Address

Phone Number

Add another nominator

Electronic Signature of Officer of the Nominator/Nominating Organization

This application (whether it is accepted or held in abeyance) shall be the property of the Canadian Agricultural Hall of Fame Association.

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Name of Nominee:

Nominated by:

Signature of Noimnator(s)

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About the Nominee

Nominee information - complete the fields below. Please include as much detail as possible.

Surname of Nominee

Given Name(s)

Year of Birth

Country of Birth

City/Region Where Born

Year of Death (if applicable)

Name of Spouse (if applicable)

Canadian Province of Residence

Current Address of Nominee (if applicable) or Family Member to be Contacted

Telephone

Education: Primary, name of school(s) attended

Education:Secondary, name of school(s) attended

Education: College or University name of school(s) attended and degree(s) completed

List of the geographical area(s) where lifetime work was accomplished

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About the Nominee continued

Contribution to Canadian Agriculture
List the achievements, results, benefits and innovations accrued to Canadian agriculture as a result of the nominee’s career and leadership.
Consider:

How did the nominee’s initiative and leadership lead to significant developments?

What impact did these achievements have in Canada? What was the benefit?

Was the nominee innovative or creative in an approach to an agriculture problem?

Why is the nominee’s contribution unique?

Lasting Legacy
Identify the nominee’s lasting legacy to agriculture in Canada.

Nominee’s Education/Certificates/Honours/Awards
What awards or recognition has the nominee received? List in chronological order.

Nominee’s Involvement in Organizations and Leadership Achievements
Chronological list of offices held, years of service, and outstanding contributions.

Nominee’s Volunteer Activities
How has the nominee volunteered time and talent to causes connected to agriculture?

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Other Comments or Supplemental Information
Your application should include letters of support (minimum 3 and maximum 10) from people who have knowledge of specific/outstanding accomplishments.
In addition to this electronic form, nominations should be submitted in hard copy to:
Canadian Agricultural Hall of Fame
Doug McDonell, Secretary-Treasurer
9102 Fifth Line, RR 3
Georgetown, ON L7G 4S6
The letters can also be emailed to secretary@cahfa.com

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