2024 VOLUNTEER AND YOUTH VOLUNTEER OF THE YEAR NOMINATION FORM Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4INFORMATION ABOUT THE NOMINATOR Your organisation's name: *Your name: *Your Phone *Your email address: *Relationship to the nominated volunteer: *NextINFORMATION ABOUT NOMINATED VOLUNTEER Volunteer's Name *Volunteer's Postal Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryVolunteer's Email Address *Volunteer's Contact Phone Number *Date of Birth *Please click all that applyVolunteering efforts support the Peel Region CommunitiesPermission has been sought to make this nomination from the individual being nominatedThis person supports a Peel Region based organisation or group/sParent/guardians have given their permission for this submission (for under 18 years of age only)NextNOMINATOR DETAILS Please select the applicable nomination category *Volunteer of the YearYouth Volunteer of the YearSummary of Achievement - Organisation 1 *Please provide details of contribution provided by the nominee, including their role, the number of years of involvement and approximate number of hours per week spent in each area. Please complete one paragraph for each organisation that the nominee volunteers for.Summary of Achievement - Organisation 2 (if required)Please provide details of contribution provided by the nominee, including their role, the number of years of involvement and approximate number of hours per week spent in each area. Please complete one paragraph for each organisation that the nominee volunteers for.Name of Organisation/Group *Role of Organisation/Group *Volunteer Role *Average hours per week *Number of weeks per year *Commencement Year *Conclusion Year (if applicable) *Second organisation/group (if applicable) Name of Organisation/GroupRole of Organisation/Group Volunteer Role Average hours per week Number of weeks per year Commencement Year Conclusion Year (if applicable) NextThe number of people reached as a result of the nominee's contribution *0-2021-5051-100101-200200 +Level of impact to those reached *12345Please tick an appropriate number between 1 and 5 with 1 indicating a positive impact on individuals and 5 indicating a life-changing impact on individualsLevel of impact to the community *12345Please tick an appropriate number between 1 and 5 with 1 indicating a positive impact on the community and 5 indicating a life-changing impact on the communityPlease provide a summary of voluntary tasks and achievements, including significant highlights or events, during the nominee’s service showcasing their positive contribution to the Peel region community. Please keep to a minimum of 100 words and a maximum of 500 words. *Name *FirstLastDate *Submit