Lieutenant Governor's Medal of Distinction in Public Administration

Lieutenant Governor’s Medal of Distinction in Public Administration Nomination Form

This is an online submission form for nominations for the 2011 Medal of Distinction. Please provide the information requested below and attach a copy of the completed nomination package in pdf format to this message.
The deadline for nominations is Friday September 23rd, 2011, 5 p.m. If you have questions or difficulties with this form, please contact us at ipac.ontario.medalofdistinction@gmail.com or 416.239.2659.

Nominee:
Nominator:
Title:
Phone Number:
Email:
Statement of Confirmation:
I confirm that to the best of my knowledge the information contained in this nomination package is complete and accurate. I also confirm that I have the original signed and dated letters of reference included in the nomination package in my possession. These and any additional documents from other external sources included in the nomination package are available for review by the Selection Committee upon request.
I agree with the above statement. Yes
Name:
Date: select
Completed Nomination Package (pdf):
Additional Comments

 

Thank you for nominating a candidate for consideration for the Lieutenant Governor’s Medal of Distinction in Public Administration. We will confirm receipt of your nomination package by email.

Ontario Groups of IPAC