Canada Cares Award Nomination Form Family, Friend or Professional 2016

Let’s Celebrate Caregivers

Caregivers are often adult daughters or sons, spouses, family members, parents of young children or close friends and neighbours. They are also health professionals from many different areas or attendants providing personal care and support.

Regardless of the scope and range of their responsibilities, Canada Cares believes those who go the extra mile deserve to be recognized for their compassion, dedication, effort and commitment to caring. As in year’s past a total of five professional and five family/friend Caregiver Awards will be selected in 2016.

Please help us celebrate those who go “above and beyond” to support and care by nominating those special caregivers in your life.

For nomination criteria on the Professional Caregiver Award click here.
For nomination criteria on the Friends and Family Caregiver Award click here.
For rules and regulations on the One Wish Award click here.

Nominator (You)

Name*:

Address*:

City*:

Province*:

Postal Code*:

Telephone*:

Email*:

Nominee

Name of caregiver you are nominating*:

Name of Individual(s) Receiving Care*:

Address of Nominee*:

City*:

Province*:

Postal Code*:

Telephone*:

Email*:

Relationship of the Caregiver to the Individual Receiving Care*:
 Spouse Parent Child Other Relative Friend Personal Support Worker Nurse Professional Live-In Caregiver Physiotherapist Occupational Therapist Other (please specify)

The Caregiver Knows He/She is Being Nominated And Is Willing To Share His/Her Story*:  Yes No

I agree to receive news, updates and promotions from Canada Cares. You can withdraw your consent at any time.*

I agree to the terms and conditions as outlined in the official awards rules.*:  Yes No

Submissions

All nominations may be submitted online or in either written or video format, and should highlight the criteria in which their category is being judged. All written submissions should contain a photo of the caregiver with the individual receiving care. Written entries must be submitted in essay or point form of 500-1,000 words. Permission must be obtained prior to publishing any story or named individual.

Upload a photo (if available) of the caregiver with the person(s) receiving care. (5MB limit)

To submit a video, please upload it to YouTube and provide the link here.

To create the best possible entry, we suggest you use the following questions as guidelines and read the full nomination criteria. Creativity is encouraged.

  1. Caregiver Situation: For whom does/did the nominee provide care and for how long?

  2. Caregiver Challenges: What obstacles/challenges has the nominee faced and overcome in his/her caregiver role?

  3. Independence & Dignity: What has the nominee done to maintain the quality of life and level of dignity of the individual(s) receiving care?

  4. Commitment to Care: How has the nominee demonstrated a commitment to caregiving beyond expectations?

  5. Community Involvement: How has the nominee enhanced the lives of others in the community?





  6. One Wish AwardONE WISH AWARD | $10,000 Is Up For Grabs

    Here’s your chance to nominate a deserving person and make a difference! Last year's winner was Barbara Aris of Nova Scotia. This year once again, one lucky caregiver will be awarded $10,000 to make their wish come true. This award is judged on the creativity of the wish and the impact that making it come true will have. You can help make a difference in a caregiver’s life, nominate them today!

    To qualify for the One Wish Award an application for either a family or professional caregiver must be submitted. In the case of a professional nomination we invite the professional to suggest an individual within their community who they feel would be eligible to win the prize. (Health professionals are not eligible to personally win the prize).

    Sponsored by CBI Health Group



  7. I wish to submit a nomination for the Canada Cares One Wish Award* sponsored by We Care Home Health Services: If you could make one caregiving wish come true using $10,000, what would it be? (*Not open to residents of Quebec)



    Or upload your story as an attachment (2MB limit; Word or PDF files only):