2025 ELCIC Leadership Award Nomination Form

2025 ELCIC Leadership Award Nomination Form
Nominee Information

Please provide the following information for the person you are nominating for the 2025 ELCIC Leadership Award.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Home Congregation (Name, City)

Nominator Information

Please provide your contact information.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Home Congregation (Name, City)

How long have you known the person you are nominating and in what capacity?

Please write a brief summary (max 200 words) indicating why are you nominating this person for the 2025 ELCIC Leadership Award.

If you have additional supporting testimonial that you would like included with your submission, please include it below. (Please note, this is optional.)
File Upload

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Thank you for your nomination for the 2025 ELCIC Leadership Award.

If you need to follow up on your nomination, please contact:
Trina Gallop Blank, 204-984-9172, tgallop@elcic.ca
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