nomination form: DEDICATION
Description
The purpose of the DEDICATION award is to recognize and reward employees who are
dedicated to the mission and values of their agency. These individuals demonstrate
unwavering loyalty and commitment to the success of a specific project or to the ongoing
interests of the agency.
Traits of Ideal Candidates
 Unwavering commitment to the goals of the organization
 Excellent and consistent performance and professionalism
 Exceptional service to external or internal customers over a sustained period
 Extraordinary levels of team spirit or leadership
 Solid support for colleagues
 Readiness to participate in special projects or committees
 Going above and beyond to make a significant contribution to their team, agency or
community
How to Submit
 Nomination forms must be submitted by email (awards@unitedwaypeel.org) no later
than Friday, May 22, 2015 at 5 p.m.
 Remember: Winners are determined solely based on the information provided on this
nomination form. Please be as specific as possible when describing
projects/accomplishments
How the Award Works
 Employees may nominate their peers but downward nominations are not accepted
 No self-nomination or nomination of family members
 All information will be verified by the nominee’s supervisor
 Achievements must occur during the time period from January 2014 to December 2014
Nominee Information
First and Last name:
Title:
Program, project, department or initiative:
E-mail:
Phone:
Agency Name
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First Nominator
Second Nominator (Optional)
First and Last name:
First and Last name:
E-mail:
E-mail:
Phone:
Phone:
Nominee’s Supervisor
First and Last name:
E-mail:
Phone:
Please select the THREE qualities that best describe the accomplishments of the
nominee.
Unwavering commitment to the goals of the organization
Excellent and consistent performance and professionalism
Exceptional service to external or internal customers over a sustained period
Extraordinary levels of team spirit or leadership
Solid support for colleagues
Readiness to participate in special projects or committees
Going above and beyond to make a significant contribution to their team, agency, or
community
Provide a specific example for each of the three qualities selected that clearly illustrates
why it applies. (150 words maximum)
Please share a story and/or project that clearly demonstrate the individual’s unwavering
dedication to the agency, as well as the positive impact or outcome for the community.
(250 words maximum)
Thank you!
An email will be sent to the primary nominator to confirm that the submission form was received.
All nominations will be reviewed by a selection panel. Award winners will be announced and
recognized during our Annual General Meeting on June 23, 2015.
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