NARMP - Nomination Form

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Nomination Call, 2007

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*Fields in red are mandatory*

My Role Model (Must be an Aboriginal youth between 13 - 30 years of age)

Ancestry:	First Nation	Inuit	Métis
Last Name:		Middle Initials:
First Name:
Address:		City / Town:
Province:		Postal Code:
Telephone:		Fax:
E-mail:		Birthday (yyyy-mm-dd):
Occupation:		First Nation / Home Community:

Nominator (Must be an Aboriginal youth between 13 - 30 years of age)
Ancestry:	First Nation	Inuit	Métis
Full Name:
Address:		City / Town:
Province:		Postal Code:
Telephone:		Fax:
E-mail:		Birthday (yyyy-mm-dd):
Occupation:		First Nation / Home Community:

References

To complete this nomination form, you must have signatures from three different people from the following categories: youth, professional, and individual. They must know your role model and agree with this nomination. The nominator cannot be a reference.



1.	Youth (Must be a youth between 13 and 30 years old)
	Name:
	Birthday (yyyy-mm-dd):
	Full Address:
	Telephone:
	E-Mail:

2.	Professional (Employed in political office, school, friendship centre, non-profit organization, etc.)
	Name:
	Full Address:
	Telephone:
	E-Mail:

3.	Individual (Any other person)
	Name:
	Full Address:
	Telephone:
	E-mail:
I (Nominator) consent to all of the information I have provided.
	Name:

Role Model Information

Please select a minimum of 5 categories that apply to your role model.

A minimum of 150 words to a maximum of 300 words for each category.


	A volunteer (e.g., do they work for free at community events? What events and how often do they volunteer? with Elders? What kind of things do they do? etc.)


	An excellent student (e.g., what is their level of education? Where do they attend school, What program are they taking? Do they work hard for good grades? What kind of academic awards have they received? etc.)


	Learning and sharing traditional teachings (e.g., are they knowledgeable in certain traditional customs hunting or cooking skills? Who did they learn them from? Do they teach to or share the traditions with others? etc.)


	An inspiring athlete (e.g., do they take part in many sports, or are they are very good at one sport? Are they part of a team? Have they won any medals? What events have they participated in? etc.)


	Keeping an Aboriginal language alive through speaking or learning it (e.g., how long have they been speaking their language? Which language do they speak? Where did they learn it from? Do they share or teach it to others? etc.)


	A talented performer (e.g., is your role model a talented fancy dancer, singer, actor or other type of performer? How long have they been performing? Where have they performed? Are they part of a group? etc.)


	A healthy person (e.g., does your role model refrain from smoking and drugs? Do they eat healthy foods and exercise? What other things do they do to keep healthy? Do they promote healthy living to others? etc.)


	A helpful person (e.g., do they help others with their work? How do they help others? Do they treat others with respect and care? etc.)


	A creative person (e.g., do they tell good stories, writes songs, paint or make nice crafts? What other ways are they creative? Do they teach others their skills? etc.)


	An entrepreneur (e.g., do they run their own business or co-own a business? What kind of business do they run? How long have they owned their business? etc.)


	Funny (e.g., do they tell good jokes and know how to make people happy through laughter?)


	Overcoming adversity (e.g., have they lost family members or had setbacks or challenges that they have had to overcome? Did they manage to move on with their life in a positive way? How have they overcome their struggles? etc.)

	What other impacts has your role model had on you, or in your community (e.g., have they won awards? For what? How are they a role model? How do they contribute to their community? etc.)