Nomination Form

The deadline for nominations is December 15, 2012.

Nominee will be asked to supply relevant supporting materials. Email addresses will be used for future correspondence for the sole purpose of promoting and administering the Arts Awards.

The main Criteria for nominations are:

• Artistic excellence
• Sustained development over a minimum of 3 years within Waterloo Region (except New Festival or Event category)
• Impact on the Waterloo Region community (includes volunteer arts involvement)

The full list of Criteria for Nominations can be found here.
A PDF version of the Nomination Form can be downloaded here.

Arts Awards Waterloo Region: 2012 Nomination Form

* Required Information

Name:*

E-Mail Address:*

Person or Organization being Nominated

Name:*

Address:*

City:*

Postal Code:*

Email Address:*

Primary Phone:*

Secondary Phone:

Artistic Category (Select One)

Categories:*

Literary - Includes all forms of creative writing, fiction, non-fiction, poetry, prose
Performing Arts - Includes theatre, dance, mime, musical, artistic or technical direction
Visual Arts - Includes painting, sculpture, multi-media, film, photography
Open - Includes arts administrator, supporter, volunteer
Music - Includes musical performance, composition, conducting
Mentor - Includes educator, instructor, leader
Leading Edge - Any arts discipline (1 or more) 25 years of age or under as of December 31, 2012
Textile, Fibre, Quilting Arts
Festival or Event
New Festival or Event
Festival or Event Volunteer

Age on December 31, 2012 for Leading Edge Category:

Indicate number of years the nominee has made a contribution to the Arts in the Region of Waterloo:

Nominator cannot be self, family member, co-habiting partner, and, when the nominee is an organization, cannot be a board or staff member of that organization:

Nominator Information

Name:*

Address:*

City:*

Postal Code:*

Email Address:*

Primary Phone:*

Secondary Phone:

Would the Nominator like to remain anonymous?*

Yes
No

Endorser must be a different person than the Nominator, must be an individual, cannot be self, family member, co-habiting partner, and, when the nominee is an organization, cannot be a board or staff member of that organization:

Endorser Information

Name:*

Address:*

City:*

Postal Code:*

Email Address:*

Primary Phone:*

Secondary Phone:

Would the Endorser like to remain anonymous?

Yes
No

Description of Contribution

Include a description of the nominee's contribution to the arts in the Region of Waterloo and why you believe the nominee would be a worthy recipient of an Arts Award:

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