Archived—Guidelines and Nomination Form 2013

    2013 Nomination Form

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    Prime Minister's Awards for Excellence in Early Childhood Education
    2013 Nomination Form

    Please type or write in BLOCK letters. Please provide a separate form for each nominee.

    Nominee's Personal Information

    Dr. Mr. Mrs. Ms.

    First Name __________________________________ Last Name ___________________________________

    (Please provide names as they should appear on certificates.)

    Home Address _____________________________________________________________________________

    City/Community ____________________________ Prov./Terr. ____________ Postal Code _____________

    Telephone (H) (____________________________ Email (H______________________________________

    Telephone (W) (___________________________ Email (W______________________________________

    Is the nominee a Canadian citizen or permanent resident?

     Yes  No

    Does the nominee work a minimum of 2.5 days per week providing direct education and care to young children?

     Yes  No

    Is this a team nomination?

     Yes  No

    Does the nominee self-identify as Aboriginal?

     Yes  No

    Personal Information

    All personal information collected in nominations is protected under the Privacy Act. It is used by Industry Canada to process the nominations and for related statistical studies. Participation is voluntary. Information will be stored in Personal Information Bank IC PPU 001. Nominees may access, request correction of, or have a notation attached to the information about them at the address in the Nomination Guidelines. Each award recipient's name, early childhood education setting, community, and work contact information are included in short biographies published for the media and online at www.pma.gc.ca. Award recipients' photographs may also be used in promotional and information materials by the Prime Minister's Awards for Excellence in Early Childhood Education.

    Nominator

    To be completed by either an individual nominator or a representative of a nominating group.

    Dr. Mr. Mrs. Ms.

    First Name __________________________________ Last Name ___________________________________

    Organization Represented (when applicable) ____________________________________________________

    Address __________________________________________________________________________________

    City/Community ____________________________ Prov./Terr. ____________ Postal Code _____________

    Telephone (H) (______________________________ Telephone (W) (______________________________

    Email (H)____________________________________ Email (W)_____________________________________

    Supervisor/Guarantor

    (Should a supervisor not be applicable, endorsement of a "guarantor" is requested, e.g. pastor, lawyer, community leader, MLA, etc. who has known you personally for at least two years.)

    Supervisor Guarantor

    Dr. Mr. Mrs. Ms.

    First Name __________________________________ Last Name ___________________________________

    Telephone (H) (______________________________ Tel. (W) (___________________________________

    Email _______________________________________ 

    Nominee's ECE Setting Information

    Name of setting ____________________________________________________________________________

    (Cash awards will be shared with this institution if the nominee is chosen for a Certificate of Excellence.)

    Address __________________________________________________________________________________

    City/Community ____________________________ Prov./Terr. ____________ Postal Code _____________

    Telephone _________________________________ Fax __________________________________________

    Email address  _______________________________________________________________________

    (when applicable)

    Website __________________________________________________________________________________

    Type of Setting _____________________________________________________________________________

    (e.g. child care centre, Aboriginal Head Start program, family child care program)

    Ages of children in nominee's care _____________________________________________________________

    Signatures

    Nominator

    Signature of Nominator ________________________________________ Date ________________________

    Nominee

    I, the nominee, affirm that all information contained in this nomination package is, to the best of my knowledge, complete and correct. I affirm that my license to operate, if applicable and certificate/diploma in Early Childhood Education and/or ECE credential is valid and in good standing. By signing this form, I authorize the Prime Minister's Awards office to conduct a verification of the information provided in this nomination. I also understand that award-winning ideas and methods will be published in an on-line exemplary practices publication and I give my release for that purpose. I have also read the Prime Minister's Awards recipient Code of Conduct found on the program website.

    Signature of Nominee _________________________________________ Date ________________________

    Supervisor/Guarantor

    By signing this form, I, the Supervisor/Guarantor support this nomination.

    Signature of Supervisor _______________________________________ Date ________________________

    (or guarantor)

    For more information or assistance in completing your nomination, please call the PMA office at 613-946-0651, or send us an Email to pmaece-ppmepe@gc.ca.

    For PMA Office Use Only

    Is evidence of the nominee's training in early childhood education and care included in the nomination package?

     Yes  No

    Is evidence that the early childhood setting in which the nominee works is licensed included in the nomination package?

     Yes  No

    Does the nominee have at least three years experience in a licensed early childhood setting?

     Yes  No

    Does the nominee work a minimum of 2.5 days per week in a licensed early childhood education setting?

     Yes  No

    Is the nomination text included in the nomination package?

     Yes  No

    Are the three letters of support included in the nomination package?

     Yes  No

    Does the nominee meet all criteria to be eligible for a PMA?

     Yes  No

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