Nomination Form
Ontario Branch Award for Leadership in Philanthropy
This award is presented in recognition of a long-standing leadership or major gift donor
(corporate, foundation or individual) whose financial support has extended over a number
of years and have had a major impact on advancing the work of the Foundation.
In the spirit of volunteerism, such an individual or group would exemplify leadership,
reliability, and commitment to activities that have demonstrated significant impact on the
kidney community and support the vision and mission of The Kidney Foundation of Canada.
Nominee
Name of Individual:
Affiliation – Kidney Foundation volunteers, members, employees and supporters:
Mailing Address:
Nominator
Name:
Phone:
Email:
Nominator Signature:
Criteria for Compiling Nominee Information:
 Nominator must complete and sign first page (if applicable) of the nomination form
 Along with the nomination, the nominator must provide information to support the
nomination of the individual for the award.
 The information sought for this award is bolded in the above description and the
criteria below can also be included as appropriate (see Criteria Definitions).
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Spirit of Volunteerism
Leadership
Public Education/Awareness
Partnership/Collaboration
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Impact
Financial
Stewardship
Innovation and Creativity
If you have any questions or concerns, please contact Carol Kostoff at ckostoff@kidney.on.ca
or 1-800-387-4474 ext. 4972.
Ontario Branch Award for Leadership in Philanthropy: Nominee Description
Please submit all information by Monday, March 7, 2016 (marked CONFIDENTIAL) to:
The Kidney Foundation of Canada
c/o Carol Kostoff
1599 Hurontario St.
Suite 201
Mississauga, ON L5G 4S1
Fax (confidential): 905-271-4954
Email: ckostoff@kidney.on.ca