Carleton North Sports Wall of Recognition Nomination Form

CARLETON NORTH SPORTS WALL OF RECOGNITION NOMINATION FORM:
NAME OF NOMINEE (FIRST AND LAST)*
NAME OF SPOUSE/PARTNER (FIRST AND LAST)*
DATE OF BIRTH MMDDYY*

MonthDayYear
Date
CURRENT ADDRESS OF NOMINIEE*

Street Address

City Province

Postal Code
TELEPHONE NUMBER OF NOMINEE*
EMAIL ADDRESS OF NOMINEE*
example@example.com
HOMETOWN (City, Town, Village identified as home of their sports career)*
DATES OF RESIDENCY IN NEW BRUNSWICK

MonthDayYear
Date
IF NOMINEE IS DECREASED, PLEASE PROVIDE DATE OF DEATH DD/MM/YY

MonthDayYear
Date
NAME NEXT OF KIN
CURRENT ADDRESS OF NEXT OF KIN

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TELEPHONE NUMBER OF NEXT OF KIN*
Candidates shall be chosen based on their total body of work and achievement including ability, sportsmanship, character, and contribution to sports and recreation. Describe how your nominee qualifies, by answering the information required in the four categories attached to this nomination.

Supporting documents (newsclips, photos, certificates, etc. ) to verify the nominee's accomplishments and additional typed information is encouraged.
NOMINIATOR INFORMATION
NAME OF NOMINATOR (FIRST AND LAST)*
ADDRESS OF NOMINATOR*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER OF NOMINATOR*
EMAIL OF NOMINATOR*
example@example.com
Nominator Signature*

Clear
I hereby declare the above details submitted to the Committee of the CARLETON NORTH SPORTS are true to the best of my knowledge and is done with consent of the nominee or their next of kin. I understand that if my nominee is not selected in this current year, their application will be kept on file for future consideration for five- years without the requirement of reapplication.

Applications due by 8:00am, June 4, 2025 to DCN Town Office. Forms may be hand delivered in a sealed envelope or mailed to 19 Station Road, Florenceville-Bristol, NB, E7L 3J8 or emailed to: rayma.rediker@carletonnorth.com. For a copy of the CARLETON NORTH SPORTS WALLOF RECOGNITION policy and guidelines go to the District of Carleton North website at: carletonnorth.com
Please indicate the category for the nominee
1. Career, Awards and Achievements: (provide information regarding the nominee's career including: the sport(s), team(s), years involved, position(s), level of competition and level of organization (community/provincial/national/international), include any awards, medals, certificates, citations, championships, etc., along with level of competition and year received.)*
2 Consistency of performance illustrate the length of time the nominee contributed to their sports including years of service teams various levels of competition progression of career practice or training regimen required to achieve their highest level*
3 Perseverance Difficulty in Achieving Success explain the perseverance and dedication of the nominee to the sport period of time contributed at each level positions held difficult circumstances encountered*
4 Personal Qualities and Contribution to the Community provide information that illustrates the nominees leadership skills character sportsmanship contribution to sport and their community Provide the significance of the impact of the nominees contribution to the local community provincial national level*
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CARLETON NORTH SPORTS WALL OF RECOGNITION NOMINATION FORM:

NOMINIATOR INFORMATION