Pinchuk Award Nomination Form 2022 – Atlantic Planners Institute

Pinchuk Award Nominations Form 2022

Nominator Information(Required)

Please share the title of the Nominator.

Nominator Name(Required)

First Last

Nominator Address(Required)

Street Address Address Line 2 City Province Postal Code

Please list the address of the Nominator.

Nominator Telephone Number(Required)

Please list the telephone number of the Nominator.

Nominator Email(Required)

Please list the email of the Nominator.

Title of Project Being Nominated(Required)

Please note the title of the project being nominated for the 2022 Pinchuk Award.

Name(Required)

First Last

Please list the first and last name of the nominee.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Please list your email.

Community Builder's Activities and Accomplishments(Required)

Outline the Community Builder's activities & accomplishments, highlighting specific initiatives and achievements.

Community Builder's Impact on Prince Edward Island(Required)

Describe how the Community Builder positively impacts our community on Prince Edward Island.

Awards, Honours, and Special Recognitions(Required)

Detail any awards, honours and other special recognitions given to the nominee for efforts in building our community on Prince Edward Island.

Is the nominee aware of this nomination?(Required)

Yes

Consent

I certify, to the best of my knowledge, that the information provided in this nomination form is correct. By checking this box, I acknowledge my consent.