Roger Marple Volunteer Award Nomination Form

Roger Marple Volunteer Award

Nomination Form
The Roger Marple Volunteer Award has been established to recognize a volunteer who exemplifies the qualities and efforts Roger Marple embodied in his daily life and his work on behalf of the Alzheimer’s Society and those living with dementia.

The nomination form includes the following components:
1. Nominator Information
2. Nominee Information
3. Nomination Submission - 4 Questions with a 500-word count limit
  1. How has the nominee demonstrated a commitment to one or more of the areas of focus of the Roger Marple Volunteer Award?
  2. How has the nominee's efforts made a positive impact related to one or more of the areas of focus?
  3. How has the nominee influenced dementia-related support, education, advocacy, and/or practices locally, provincially, and/or nationally?
  4. How has the nominee been innovative and/or overcome barriers within their activities? Are there any achievements to note of the nominee?
4. Letter of Support Submission - 2-page limit
5. Consent & Verification of Nomination Information

Nominator's Information
Name of person nominating the volunteer:*

First NameLast Name
Organization of person nominating volunteer (if applicable):
Phone Number:*
Email:*
example@example.com
City/town and Province:*

Nominee's Information
Name of volunteer being nominated:*

First NameLast Name
Email:*
example@example.com
Organization(s) of volunteer being nominated (if applicable):
Phone Number:*
City/Town and Province:*

Nomination Submission

Please provide as much detail and examples as possible for the Award Selection Committee while staying within a 500 word count limit for each question.
(Not a requirement) Is the nominee affiliated with the Alzheimer Society of Alberta and Northwest Territories? If yes, please describe below:
Please provide an overview of actions, initiatives, and/or strategies the volunteer has used to support, influence, and/or recognize people living with dementia, an enhanced quality of life for people living with dementia, the reduction of dementia-related stigma, and/or the promotion of dementia supportive communities.
How has the nominee demonstrated a commitment to one or more of the areas of focus of the Roger Marple Volunteer Award?*

Areas of Focus: People Living with Dementia Projects/Programs/Services, Enhancing Quality of Life for People Living with Dementia, Reducing Stigma Related to Dementia, and Promoting Dementia Supportive Communities0/500
How has the nominee's efforts made a positive impact related to one or more of the areas of focus?*

Areas of Focus: People Living with Dementia Projects/Programs/Services, Enhancing Quality of Life for People Living with Dementia, Reducing Stigma Related to Dementia, and Promoting Dementia Supportive Communities0/500
How has the nominee influenced dementia-related support, education, advocacy, and/or practices locally, provincially, and/or nationally?*

0/500
How has the nominee been innovative and/or overcome barriers within their activities? Are there any achievements to note of the nominee?*

0/500

Letter of Support
Please attach a letter of support for the nomination explaining why the nominee deserves the award. This letter may come from the nominator or another person who can attest to the nominee's efforts. (maximum 2 pages)
Letter of Support Attachment*

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In submitting a nomination, the nominee and nominator consent to the nomination being submitted and verify that the details submitted are accurate. The nominee also consents to the materials submitted and their story being shared on the Alzheimer Society of Alberta and Northwest Territories' website, newsletters, and social media platforms.*

Yes, the nominee has consented to the nomination and has confirmed that information provided within the nomination is accurate.No, the nominee has not confirmed their consent to the nomination and/or the information provided being accurate.
Thank you for your nomination!

All nominees will be notified of the outcome in mid December, and all nominees are encouraged to attend the Annual General Meeting in January where the winning nominee will be announced.
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Roger Marple Volunteer Award

Nominator's Information

Nominee's Information

Nomination Submission

Letter of Support

Thank you for your nomination!