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Environmental Recognition Award and Nomination Form

The City of Brantford will present Environmental Recognition Awards in a variety of categories. Please complete the following nomination form for one category and person/group/company/family.

Nominee Information:

First name

Last name

Street number

Street name

Unit number

City

Postal code

Phone number

Email address

Re-enter email address

Category (please select one)

Lifetime Achievement

Environmental Volunteer

Young Environmental Champion – Secondary Age

Green Non-Profit

Greenest Family

Young Environmental Champion – Elementary Age

Green Business

Please fill out ALL applicable sections. If a section is not applicable, please leave it blank.

Describe how the person/group/company/family reduces energy use. (i.e. energy efficient appliances, lightbulbs, policies, etc.)

Describe how the person/group/company/family reduces water use. (i.e. rain collection, water reduction, water filtration, grey water system)

Describe how the person/group/company/family diverts waste through reduce, recycle, and reuse principles. (i.e. backyard composters, using reusable shopping bags, packing lunches in reusable containers)

Describe how the person/group/company/family has reduced their environmental footprint or furthered sustainability in any other way. (i.e. using green cleaning or green certified products)

How does the person/group/company/family support environmental initiatives in the community? (i.e. sponsorship, community clean-ups, restoration, green awareness, etc,)

How does the person/group/company/family directly and positively impact the environmental health of Brantford? (i.e. protecting vegetation and wildlife, increasing milkweed habitat, reducing contaminants in the environment)

How has the person/group/company/family made measurable improvements in sustainability, education, advocacy, green infrastructure or environmental restoration?

Lifetime Achievement Nomination and Environmental Volunteer nominees – how many years of dedicated services or volunteer time have they committed?

Young Environmental Champion Nominees – what leadership was demonstrated by the youth?

Please upload any support materials, including photographs, articles or other materials that support their nomination.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Nominator Information:

First name

Last name

Street number

Street name

Unit number

City

Postal code

Phone number

Email address

Re-enter email address

I acknowledge that the personal information collected on this form is collected in accordance with Section 10(1) of the Municipal Act, 2011, c.25 and will be used to contact nominators should additional information on be required; to notify nominees; and to notify the public of the list of nominees received for the City of Brantford Environmental Recognition Award. Please note that the names of all nominees will be made public. The disclosure of all other personal information on this form will be done in accordance with the provisions of the Municipal Freedom of Information and Protection of Privacy Act. Should you have any questions regarding the collection, use and disclosure of this personal information, please contact the Deputy Clerk/Manager, Legislative Services Division at Brantford City Hall, 58 Dalhousie St, Brantford, N3T 2M2 or by telephone at 519-759-4150 during regular business hours.

I Agree

Yes