Application Form - Lieutenant Governor’s Youth Medal

Instructions

Maintain discreetness surrounding each nomination to avoid disappointment, uneasiness or discomfort for the person or organization submitting the application if it is unsuccessful; at the end of the selection process, the Lieutenant Governor's Chief of Staff and Private Secretary will inform the nominees by letter and formal invitation. The awarding of the medal is not automatic.
Use accents, hyphens and upper- and lower-case letters.
Fields marked with an asterisk (*) are mandatory. Failure to complete a mandatory field will prevent you from proceeding to the next step.
Please do not use all capital letters; this is not permitted and will result in the rejection of the form.
Be sure to correctly spell the nominee's first and last names at birth, as this information will be used as provided for the designation of the recipient.

You must ensure that the nominee meets the program's eligibility criteria, particularly the criteria of being a Canadian citizen or permanent resident within the meaning of the Immigration and Refugee Protection Act (SC 2001, c 27) and residing permanently in Quebec.

* Mandatory field

Information on the nominee

First name* :

Last name at birth* :

Date of birth* :

Email* :

Confirm email again* :

Contact details for the nominee

Civic number* :

Street name* :

Apartement :

PO Box :

Municipality* :

Province : Quebec

Postal code* :

Phone number (day)* :

Extension number :

Other phone number :

Other extension number :

In which language should we address the nominee?

Choose language* :

FrenchEnglish

Text introducing the nominee: what makes the nominee distinct?

In a text of no more than 400 words, written appropriately, please describe how the nominated person stands out and meets the following criteria:

has demonstrated sustained volunteer commitment in the social or community sphere;
has shown an inspiring attitude and a positive influence within a group or the community;
is able to achieve the objectives of their study program;
and the ways in which they stand out.

Here are a few recommendations:

Avoid writing a text that is merely a curriculum vitæ-itemization or a simple list of associations or actions. Do not reproduce, word for word, a text written by the nominee, since your text must be in the third person. If you fail to meet this requirement, the application may be rejected.
Avoid using acronyms or abbreviations when naming committees, organizations or clubs. Please provide the full name of each organization and, if necessary, a brief explanation of its nature.
Choose clear, meaningful words to describe the nominee's praiseworthy actions.
Write your text in the language (French or English) in which you would like the recipient to be presented during the ceremony.

Number of words entered : 0 / 400

In accordance with our writing guidelines, you must also provide a summary, in no more than 60 words, of the nominee's main achievements and their influence in the community or organization. This text will be used to introduce the recipient at the award ceremony.

Number of words entered : 0 / 60

Educational institution

Official and complete name of the organization* :

Please, as much as possible, write the official and specially complete name of your institution, avoid acronyms.

Please enter the institution's or the person in charge's email* :

The invitation for the education establishment representatives will be sent to this email

Administrative region of the organization* :

The designated administrative region will determine the location of the Medal presentation ceremony for the nominated person. Please ensure the accuracy of the selected region.

Principal / Director general / Rector of the educational institution

Title* :

MrMsOther

First name* :

Name* :

Title / position* :

Please, as much as possible, write the official and especially complete name of your title / position, avoid acronyms.

Mailing address of the educational institution

Civic number* :

Street name* :

Office :

PO Box :

Municipality* :

Province* :

Postal code* :

Person to contact regarding the nomnation at the educational institution

Title* :

MrMsOther

First name* :

Last name* :

Title* :

Please, as much as possible, write the official and especially complete name of your title / position, avoid acronyms.

Phone number (day)* :

Extension number :

Email* :