Nomination
Form
Thank you for your interest in recognizing outstanding young people, age 6 to 17, who are performing worthwhile community service,
are contributing to their communities while living with limitations, have performed acts of heroism, excellence in personal achievements,
or are ‘good kids’ who are making life better for others and doing more than expected of someone their age.
Every nominee will receive a Certificate of Recognition.
Up to 12 individual final recipients may be chosen as Ontario Junior Citizens and will be announced March 11, 2022 at www.ocna.org.
Nominations must be received by February 11, 2022. Email to jr.citizen@ocna.org.
Please submit the completed Nomination Form with at least two Supporting Forms (enclosed) for each individual nomination. Please
be as thorough as possible and include newspaper articles, letters, and other information that will help the judges get to know your
nominee.
About YOU, (the NOMINATOR):
Name of person completing the nomination:
Street address:
102 Headwater Cres
Town: Richmond Hill
Postal code: L4E 0T2
Phone (Res.): 647-739-4551
Phone (Bus.):
E-mail: wallerchen@hotmail.com
My relationship with the nominee is: ____
x relative
____ teacher
____ other (please specify):
x I give permission to contact me about this program electronically
Date: 2022-01-18
Signature:
You will receive a letter acknowledging receipt of your nomination by the first week of March, otherwise please e-mail
jr.citizen@ocna.org.
Parental Consent:
I hereby acknowledge and approve of the release of information in this nomination for the purpose of the Awards program.
(The full PIPEDA policy is available at www.ocna.org/juniorcitizen)
Parent/Guardian’s Signature:
About the NOMINEE:
Name of Nominee: Vincent Zheng
Street address: 102 Headwater Cres
Town: Richmond Hill
Postal code: L4E 0T2
Date of Birth: 2006-05-31
Parent’s Name: Waller and Xueqin
Phone (Res.): 647-974-8951
E-mail: vincentzheng55@gmail.com
Nominee’s local weekly newspaper:
Phone (Parent’s Bus.):
Nomination Information
Please indicate in which category your young person is being nominated:
x involved in worthwhile community service
___
___ contributing to the community while living with a disability (physical or psychological)
___ performed an act of heroism (December 2019 to December 2021)
___ excellence in personal achievements
___ a ‘good kid’ who does more than is expected of someone of that age
Describe the involvement this person has in groups and organizations, and please include time frames (eg. Sarah has been involved in
the Fundraising Committee at her church for the past two years by spending each Wednesday evening doing xxx, or John has been
mowing his elderly neighbour’s lawn for the past two summers).
During last summer, Vincent has been helping and teaching children the basics of tennis at Philpott Children's Tennis, a
non-profit organization. He had spent every weekday of his summer helping out and teaching children tennis.
What has the nominee accomplished through his or her activities (e.g. collected toys for sick children, donated 1,000 items for local
charity, etc.)? Please include results achieved, current project status and any awards or recognition received. What impact has it had
on their community?
Indicate any challenges the nominee had to overcome to achieve this.
Describe how the nominee’s personality and/or attitude supports this nomination.
What has inspired this person to be involved in these activities/achieve excellence?
Outline how your nominee contributes at school and in his/her community if it is not already outlined above. Include references to
academic achievements as well as involvements in extra-curricular activities and community groups with time frames.
Certificates/Diplomas /etc. can be listed here - copies do not have to be submitted.
Additional comments
Each nomination must include at least two Supporting Nomination Forms (completed by individuals other than the primary
nominator).
Any additional support and references are welcomed.
Please keep in mind that the award selection is based on the information you provide on the nominee. We receive many nominations
each year and unfortunately, some are eliminated from the judging process due to a lack of information. Provide as much background
as possible on the young person you are nominating. Additional support material regarding your nomination (such as letters of
endorsement, newspaper clippings, and so on) would be helpful to the judges.
Send completed nominations, including 2 supporting Nomination Forms, by February 11, 2022 to jr.citizen@ocna.org.
Supporting
Nomination Form
Please note: Supporting Nomination Forms must be completed by at least two individuals other than the primary nominator.
The following young person is being nominated as an Ontario Junior Citizen.
Name of nominee:
Address:
Nominees are outstanding young people, age 6 to 17, who are performing worthwhile community service, are contributing to their
communities while living with limitations, have performed acts of heroism, or are ‘good kids’ who are making life better for others and
doing more than expected of someone their age.
Your help, by completing this Supporting Nomination Form, would be appreciated. Once complete, please return to the Primary
Nominator.
Your name:
Street address:
Town:
Postal code:
Phone (Res.):
Phone (Bus.):
E-mail:
My relationship with the nominee is: _____ relative
_____ teacher
The reason you are willing to support this nomination:
Date:
Signature:
_____ other (specify):
Supporting
Nomination Form
Please note: Supporting Nomination Forms must be completed by at least two individuals other than the primary nominator.
The following young person is being nominated as an Ontario Junior Citizen.
Name of nominee:
Address:
Nominees are outstanding young people, age 6 to 17, who are performing worthwhile community service, are contributing to their
communities while living with limitations, have performed acts of heroism, or are ‘good kids’ who are making life better for others and
doing more than expected of someone their age.
Your help, by completing this Supporting Nomination Form, would be appreciated. Once complete, please return to the Primary
Nominator.
Your name:
Street address:
Town:
Postal code:
Phone (Res.):
Phone (Bus.):
E-mail:
My relationship with the nominee is: _____ relative
_____ teacher
The reason you are willing to support this nomination:
Date:
Signature:
_____ other (specify):