Test Nomination - Courage To Come Back Awards

27th Courage To Come Back Nomination Form

The online nomination form for the 27th Courage To Come Back Awards.

SECTION 1: Nominator Information
Nominator Salutation
Nominator First Name*
Nominator Last Name*
Nominator Address*
Nominator City*
Nominator Province*
Nominator Postal Code*
Nominator Phone*
Nominator Alternate Phone
Nominator Email*
Nominator Relationship to Nominee*
In a few sentences, please tell us the top One to Three reasons why you decided to nominate this person for a Courage To Come Back Award and how they have inspired you & the positive impact they have had on others and/or the community?*
How did you hear about The Courage To Come Back Awards?*
SECTION 2: Nominee Information
Award Category*
- Addiction: A person who has demonstrated inspirational achievements overcoming the challenges of addiction and who has given back to his or her community. Sobriety must have been maintained for at least the past five (5) years.
- Medical: A person who has demonstrated inspirational achievements overcoming the challenges of a medical condition, either from birth or developed in their lifetime, or following major trauma or injury which has required extensive physical rehabilitation, and who has given back to his or her community.
- Mental Health: A person who has demonstrated inspirational achievements overcoming the challenges of living with a mental illness, and who has given back to his or her community.
- Young Adult: A young person, between 19 - 25 years old, who has demonstrated inspirational achievements overcoming mental illness, injury or addiction and who has given back to his or her community.
Addiction Category Confirmation*
Please confirm the nominee has maintain a minimum of 5 years of sobriety
Nominee Date of Birth*
MM slash DD slash YYYY

Necessary to process a Youth Award nomination.
What racial or ethnic group best describes the nominee?

Optional
Nominee Salutation
Nominee First Name*
Nominee Last Name*
Nominee Address*
Nominee City*
Nominee Province*
Nominee Postal Code*
Nominee Phone*
Nominee Alternate Phone
Nominee Email*
SECTION 3: Nomination Criteria
Please provide details of how the nominee satisfies each of the four criteria, with specific examples for each.
Criteria 1: The full history and nature of the illness, injury, addiction or adversity. The impact on the nominee’s life. Please be specific and concise. Type response below.*
There is a 600 word maximum (4200 character count including spaces).
Criteria 2: Type of obstacles encountered, degree of difficulty involved in overcoming them. Please be specific and concise. Type response below.*
There is a 600 word maximum (4200 character count including spaces).
Criteria 3: The personal and/or professional goals and achievements the nominee has reached in spite of setbacks, obstacles, adversity or illness. Please be specific and concise. Type response below.*
There is a 600 word maximum (4200 character count including spaces).
Criteria 4: Details of how the nominee has given back to the community (such as mentoring, volunteering, public speaking, fundraising, other good works). Please note that community can also refer to an online or virtual group. Please be specific and concise. Type response below.*
There is a 600 word maximum (4200 character count including spaces).
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For Nominee to complete: In your own words and in chronological order (if possible), please describe your journey, from your perspective and how it has impacted your life. We encourage you to focus on your 'Come Back' & how you 'Give Back', and what motivates you to do so. Also, feel free to provide more details about any of the aspects already covered in the rest of the nomination, or add anything that is important to you that may have been missed. If relevant and you feel comfortable, please include how your demographic background has impacted your journey.
There is a 600 word maximum (4200 character count including spaces).
SECTION 4: Submitting your nomination checklist
Nomines is British Columbian*
- By checking this box, I confirm that the Nominee lives in the Province of British Columbia. *
Nominee has agreed to be nominated*
- By checking this box, I confirm that the Nominee has agreed to be nominated by me for a Courage To Come Back Award. *
I agree that statements made by me are true*
- By checking this box, I confirm that the statements made by me, the Nominator, regarding this Nominee are true and represent my honest opinions, beliefs and experiences. *
SECTION 5: Letters of support
IMPORTANT: You must ensure that three (3) testimonial letters by others in support of the nomination are submitted:
UPLOAD: Please upload your three (3) letters of support below and in .pdf or .doc files. If you encounter any issues, please email courage@coastmentalhealth.com.
File
Drop files here or

Accepted file types: jpg, pdf, doc, docx, Max. file size: 100 MB, Max. files: 3.
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27th Courage To Come Back Nomination Form

SECTION 1: Nominator Information

SECTION 2: Nominee Information

SECTION 3: Nomination Criteria

SECTION 4: Submitting your nomination checklist

SECTION 5: Letters of support

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