Table of Contents

John H. Chapman Award of Excellence Form

A. First, upload all relevant documents

Please upload this document before completing the rest of the form.

• Biography of candidate and collaborators (500 words)
• Description of the achievement (500 words)
• Two recent digital photographs* of the candidate
• Three to ten digital images* illustrating the achievement for which the candidate is nominated
• Three letters in support of the nomination

* Images must be high-resolution, JPEG format, on a CD-ROM, and copyright free.

Guidelines:

• You may attach up to 5 documents.
• Each document can be up to 5MB maximum.
• Documents must be one of the following formats: PDF, DOC, JPG (downloads format).
• Uploading after completing the form will result in your information being lost.
• Once you have uploaded these documents, you will have 20 minutes to fill in the form. Please have all the information about the event nearby so you can respond before the form expires.
  
  
• Choose your file by clicking on Browse and then click on Attach.
  
  
    
  
  

B. About the sponsoring organization or individual

* Fields preceded by a red star are mandatory.

* Name:
 

* Title:
 

* Organization:
 

* Address with number and street name:
 

* City:
 

* Province: Select one: Alberta British Columbia Prince Edward Island Manitoba New-Brunswick Nova-Scotia Nunavut Ontario Quebec Saskatchewan Newfoundland and Labrador Northwest territories Yukon Other country
 

* Postal code:  (e.g. J3Y8Y9)
 

* Telephone:  (e.g. 450-123-4567)
 

Fax:  (e.g. 450-123-4567)
 

Cellular:  (e.g. 450-123-4567)
 

* E-mail address:
(important: indicate one address only)
 

Retype to confirm e-mail address:
 

C. About the candidate

* Name:
 

* Title:
 

* Organization:
 

* Address with number and street name:
 

* City:
 

* Province: Select one: Alberta British Columbia Prince Edward Island Manitoba New-Brunswick Nova-Scotia Nunavut Ontario Quebec Saskatchewan Newfoundland and Labrador Northwest territories Yukon Other country
 

* Postal code:  (e.g. J3Y8Y9)
 

* Telephone:  (e.g. 450-123-4567)
 

Fax:  (e.g. 450-123-4567)
 

Cellular:  (e.g. 450-123-4567)
 

* E-mail address:
(important: indicate one address only)
 

Retype to confirm e-mail address:
 

D. About the collaborator(s) (if necessary)

It may be that individuals whose efforts deserve recognition have collaborated with the candidate. Please list these individuals.

Collaborator 1

Name:
 

Title:
 

Organization:
 

Address with number and street name:
 

City:
 

Province: Select one: Alberta British Columbia Prince Edward Island Manitoba New-Brunswick Nova-Scotia Nunavut Ontario Quebec Saskatchewan Newfoundland and Labrador Northwest territories Yukon Other country
 

Postal code:  (e.g. J3Y8Y9)
 

Telephone:  (e.g. 450-123-4567)
 

Fax:  (e.g. 450-123-4567)
 

Cellular:  (e.g. 450-123-4567)
 

E-mail address:
(important: indicate one address only)
 

Retype to confirm e-mail address:
 

Collaborator 2

Name:
 

Title:
 

Organization:
 

Address with number and street name:
 

City:
 

Province: Select one: Alberta British Columbia Prince Edward Island Manitoba New-Brunswick Nova-Scotia Nunavut Ontario Quebec Saskatchewan Newfoundland and Labrador Northwest territories Yukon Other country
 

Postal code:  (e.g. J3Y8Y9)
 

Telephone:  (e.g. 450-123-4567)
 

Fax:  (e.g. 450-123-4567)
 

Cellular:  (e.g. 450-123-4567)
 

E-mail address:
(important: indicate one address only)
 

Retype to confirm e-mail address:
 

E. Submit the form