Prescott and Russell jp st. Pierre Award



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Prescott and Russell JP St. Pierre Award
Nomination Form
Required fields are marked with an asterisk (*).

The JP St. Pierre Award is bestowed upon deserving individuals residing in the United Counties of Prescott and Russell (UCPR).
This high municipal distinction aims to celebrate the exceptional contributions of individuals in the many areas of life within the UCPR, including arts and culture, business and professions, charitable work, health, education, public service, media and communications, sports, agriculture, the environment, or other areas contributing to the well-being of the UCPR’s citizens.
A maximum of two awards will be presented on an annual basis..
Nominee Information :

* Mr.             Mrs.            Ms.            Dr.            Other   

* First Name:

* Last Name:

* Home address:

* City :

* Postal Code :

* Home Telephone Number: (e.g., 613-555-5555)

Other Telephone Number: (e.g., 613-555-5555)

E-mail Address:

Organization (if applicable):

Nominator Information (your name)



Nominations by immediate family members, self-nominations, and posthumous nominations will not be accepted.

* Mr.              Mrs.             Ms.           Dr.            Other    

*First Name :

* Last Name:

* Relationship to Nominee:

* Street Number:

* Street Name:

Unit/Apt/Suite:

* City:

* Postal Code:

* Home Telephone Number: (p. ex., 613-555-5555)

Other Telephone Number: (p. ex., 613-555-5555)

* E-mail Address:

Summary of Nominee’s Achievements 

Each nomination form MUST include a short summary of the nominee’s contribution or accomplishments.

* 1) Overview of why you are nominating the candidate (max.250 words)

2) Written testimonials from at least two individuals (including contact information), other than the nominator, who have first-hand knowledge of the nominee’s accomplishments (max.350 words)

Testimonial # 1

* Mr.             Mrs.            Ms.           Dr.          Other     

*First Name:

* Last Name :

* Home Telephone Number: (p. ex., 613-555-5555)

Other Telephone Number: (p. ex., 613-555-5555)

E-mail Address:

*Please ensure that you include sufficient information to give the Selection Committee a clear idea of the nominee’s character and the impact of his/her contribution..

Testimonial # 2

* Mr.             Mrs.            Ms.           Dr.          Other     

*First Name:

* Last Name:

* Home Telephone Number: (p. ex., 613-555-5555)

Other Telephone Number: (p. ex., 613-555-5555)

E-mail Address:

*Please ensure that you include sufficient information to give the Selection Committee a clear idea of the nominee’s character and the impact of his/her contribution..

3) Additional material in support to this nomination (i.e. testimonial letters, media stories, tribute, etc.) that provides new information and insight into the nature of the nominee’s accomplishments can be sent by



e-mail to prix-jpstpierre@prescott-russell.on.ca or mailed to : United Counties of Prescott and Russell, Prescott and Russell JP St. Pierre Award Selection Committee, c/o Justin Bromberg, 59 Court St., P.O. Box. 304, L’Orignal, Ontario K0B 1K0.
Information collected will only be used to evaluate nominees and notify recipients of the Prescott and Russell JP St. Pierre Award.
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