| *Fields in red are mandatory* |
| PART A – NOMINATOR & ROLE MODEL INFORMATION |
| Please complete in full. The nominator (you) and role model must both be a First Nations, Inuit or Métis youth between the ages of 13 to 30 years old. |
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| PART B – REFERENCE INFORMATION |
| You must have 3 references: youth, professional and any individual. They must know your role model and agree with this nomination. The nominator (you) cannot be a reference. |
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| PART C – CATEGORY INFORMATION |
| 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. |
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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.) |
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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.) |
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ABORIGINAL CULTURE (e.g., are they learning, sharing or 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.) |
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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.) |
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ABORIGINAL LANGUAGE (e.g., are they keeping an Aboriginal language alive through speaking or learning it? 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.) |
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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.) |
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HEALTHY (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.) |
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HELPFUL (e.g., do they help others with their work? How do they help others? Do they treat others with respect and care? etc.) |
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ARTISTIC (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.) |
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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.) |
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FUNNY (e.g., do they tell good jokes and know how to make people happy through laughter?) |
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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.) |
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OTHER IMPACTS (e.g., what other areas have they impacted you and your community? Have they won awards? For what? How are they a role model? How do they contribute to their community? etc.) |
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| PART D – SUPPORTING DOCUMENTS |
In addition to your online nomination please forward the following:1) BIOGRAPHY OR RESUME OF YOUR ROLE MODEL
- Must be at least 1 page in length. It must include their background information. How have they contributed to their community?
2) LETTER OF SUPPORT
- A letter of support must be provided by one of your references (maximum of 3).
- It must include how they know your role model and that they agree with this nomination.
- Explain how the role model is leading their way and is an example for Aboriginal youth to follow.
Please submit your supporting documents by:
EMAIL:
leadyourway@naho.ca
FAX:
(613) 233-1853
MAIL:
National Aboriginal Role Model Program
National Aboriginal Health Organization
220 Laurier Avenue West, Suite 1200
Ottawa, ON K1P 5Z9
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