Steward of the Year NOMINATION FORM - NCR 

Please attach one completed nomination form or photocopy to your nomination materials. Please print or type on nomination form (except for signature requirements). Nominations are considered to be made by the actual signers, even if representing a group of members. The first signed nominator will be considered the sponsor and will be the contact with the Awards Committee. 

Nominee's Personal Information 
Name (in full):                                                                                                              

Business Address: 
Business Telephone Number:                                                                                          

Residence Address: 
Residence Telephone Number:                                                                                       

Present Occupation or Title:                                                                                              

NOMINATION 
I (We), the undersigned, hereby nominate _ , for consideration by the NCR Awards Committee for Steward of the Year. Our nominee is a Steward in good standing of the Professional Institute of the Public Service of Canada (PIPSC), and we 
testify to the Steward's good character and high ethical standards. We, the undersigned, have read and understand the procedures and terms of reference for this award, and have read and do verify all supporting evidence attached to this nomination. 
NOMINATORS (note - first signed nominator is considered the sponsor and main contact) DATE:                                                                                                                          
1. Name:                                                                                    

Occupation:                                                                                                                   Address: Tel. (bus.):    

(res.):      

PIPSC Steward: Y  N  
Signature: 

2. Name:                                                                                    

Occupation:                                                                                                                   Address: Tel. (bus.):    

(res.):      

PIPSC Steward: Y  N  
Signature:    

3. Name:                                                                                    

Occupation:                                                                                                                   Address: Tel. (bus.):    

(res.):      

PIPSC Steward: Y  N  
Signature:    

For Office Use Only  
Date Received:                                                    

To Committee:                                              
Committee Action:                                              

Council Action:                                               
Remarks: