SUBMISSION

Please fill in unshaded areas.   Explanatory comments in red may be deleted.

Method

mail or email?

Items to follow

Indicate if any items are sent separately. How?

Restricted to:

LIST OF OPTIONAL ATTACHMENTS  Please label each attachment with the name of the Nominee.

1 Nominee photo

Provide a caption & a reference name (e.g. filename) that easily identifies each attachment

1 Success photo

e.g. conservation work, protected site

1 brief document  

e.g. brochure, media

NOMINEE

Year

2006

Award Category

Individual, Group, Youth or Lifetime Achievement  (see guidelines)

Name

Full name of person or group nominated

Program

If a specific program is nominated for a group, provide its name – leave blank if not applicable

Contact Person

(for group)

Phone

Work / Home

Mailing Address

Full Mailing address including City and Postal Code

Email

Website

(if applicable)

NOMINATOR

Name

Organization

(if applicable)

Phone

Work / Home

Mailing Address

Full Mailing address including City and Postal Code

Email

Website

(if applicable)

CONSERVATION SUCCESS

Sector

(e.g. Agriculture, Media)

Type

(e.g. Volunteer, Professional, non-profit, Business)

Who? 

Describe the nominee.  If a group or partnership, who is involved?

Summary

Provide a brief summary of conservation achievement (~ 50 words). 

When? 

Provide a timeframe.  E.g. Start time and Duration

Where? 

Provide location, size & area influenced  e.g. property, school yard, community, region

Why? 

What makes this nominee exceptional? What have they done that is beyond the call of duty?

Impacts & Effects 

How has the work of the Nominee influenced others and who benefits? 

Carolinian links 

What is the relevance to conservation in the Carolinian life zone?

Ú List

CONSERVATION ACCOMPLISHMENTS

Describe each accomplishment – be specific& provide examples

(provide quantitative information where appropriate e.g. approximate number of trees planted)

(Insert rows as needed)

Other comments

(Nomination should be 3 pages or less)