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):