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Why Give?
2023 Peace Medal Nomination Form
Nominee
Information
Medallion Category
Youth
Adult
Title
Mr.
Mrs.
Ms.
Miss.
First Name
Last Name
Group / Organization Name (If Applicable)
Mailing Address
Street Name
Apt #
City
Province
Postal Code
Phone
Cell Phone
Email
Nominator
Information
Title
Mr.
Mrs.
Ms.
Miss.
First Name
Last Name
Mailing Address
Street
Apt #
City
Province
Postal Code
Phone
Cell
Email
Relationship to Nominee
Reference
Title
Mr.
Mrs.
Ms.
Miss.
First Name
Last Name
Mailing Address
Street
Apt #
City
Province
Postal Code
Phone
Cell
Email
Relationship to Nominee
Provide a brief history of the individual or organization’s work to do good
How has the nominee inspired you and others through their acts of peace?
How does the nominee demonstrate their commitment to doing good and building peace?
What is the impact of the nominee's peacemaking work on the local, national, or global community?
Describe any collaboration between the nominee and other groups and individuals
Additional Information
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