Volunteer Appreciation Award Application

The purpose of this program is to recognize and honour volunteers who demonstrate generosity of time and spirit by achieving outstanding results as a volunteer, inspiring others to service or making an extraordinary contribution to a community benefit organization or by championing an issue.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.

Fill out the form below or download the printable PDF.

Nominee Information

Name of Nominee *

First

Last

Nominee's Email *

Nominee's Phone

Nominee's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Nominator Information

Name of First Nominator *

First

Last

First Nominator's Email *

First Nominator's Phone

First Nominator's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Name of Second Nominator *

First

Last

Second Nominator's Email *

Second Nominator's Phone

Second Nominator's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

File Upload – Statement of Nomination (maximum 2 pages) and Nominee Biography (maximum 250 words)

Click or drag files to this area to upload. You can upload up to 4 files.

Declaration of Accurracy *

Clear Signature

I have read the nomination rules, regulations and criteria and certify that they accurately describe my nominee’s volunteer work. I agree that my nominee’s voluntary work was not performed as a condition of salaried employment, or solely as a requirement of any educational or professional course. I also attest to the fact that the volunteer is aware and approves of this application.

Freedom of Information Disclaimer
Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.