fillable form

HEROES IN THE HOME
Caregiver Recognition Awards
“Nearly 80% of all caregiving in Canada is provided by volunteers,
usually relatives. Until now, they have laboured away from the
spotlight.” ~ Ron Farrell, North East CCAC Board Chair
We know that most volunteers would never seek out recognition; they do what they do out of compassion
and love. That’s why the North East Community Care Access Centre is so proud to launch the second annual
HEROES IN THE HOME – Caregiver Recognition Awards.
Do you know someone who has made a difference in your life or played a role in helping a loved one live more
comfortably and independently at home? They could be family members, friends, or neighbours – men and
women who give of their time and themselves to provide meals, housekeeping, transportation, banking, or
simply conversation. They could also be paid caregivers who have gone above and beyond their typical roles to
support a person in need.
Why not nominate the hero in your life for a 2015 Caregiver Recognition Award? Simply complete the nomination
form online and click submit, or print and forward by mail to:
Brianne Benoit
North East CCAC
40 Elm St., Suite 41C
Sudbury ON P3C 1S8
Need help, or prefer to nominate someone by phone? Please call Brianne toll-free at 310-2222
(no area code required).
All nominees will receive a certificate of recognition during a special public reception in your region.
NOMINATION FORM
Caregiver Recognition Awards
My Hero in the Home is:
Caregiver (first and last name)
City
Phone
Email
❑ The caregiver is aware of this nomination.
My name is:
Nominator (first and last name)
City
Phone
Email
I am interested in attending the recognition ceremony
■ Yes ❑ No
❑
In 500 words or less, describe how this person has gone above and beyond to be your “Hero in the Home.”
Please limit the amount of personal medical information you include. (We’d love to see a photo of you and
your nominee. Please include with your nomination.)
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Please fill out and return this form on or
before September 4, 2015 to:
All Heroes in the Home Recognition Ceremonies will be held
from 2:00 – 3:30 pm:
Brianne Benoit
North East CCAC, 40 Elm Street, Suite 41C
Sudbury ON P3C 1S8
Toll-free: 310-2222 ext. 4547
(no area code required)
[email protected]
September 28, 2015
September 29, 2015
October 15, 2015
October 22, 2015
November 9, 2015
November 10, 2015
Timmins; McIntyre Auditorium
Kirkland Lake;Église de L'Assomption (Church)
Sault Ste. Marie; Senior Drop-In Centre
Parry Sound; Bobby Orr Community Centre
Sudbury; Pioneer Manor
North Bay; Royal Canadian Legion Branch 23
SUBMIT