Human Rights Award Nomination Form

"*" indicates required fields

Nominee’s name (person or group being nominated)*

Nominee’s address*

Street Address Address Line 2 City Province/territory Postal Code

Nominee’s phone number*

Nominee’s email*

Date form was completed

Briefly describe the types of human rights activities in which the nominee is/was involved.

How are the nominee’s activities promoting human rights, equality and inclusion in Newfoundland and Labrador?

What impact has the nominee’s activities had in Newfoundland and Labrador? In what geographical area within Newfoundland and Labrador?

Briefly describe why this nominee is deserving of this award.

Any additional information you wish to provide.

Please attach any documents that may be relevant to this nomination.

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 10 MB, Max. files: 5.

Nominator’s name (group or individual)*

Nominator’s address*

Street Address Address Line 2 City Province/territory Postal Code

Nominator’s phone number

Nominator’s e-mail*

Nominator’s relationship to nominee

The collection of this information is authorized under sections 61(c) of the Access to Information and Protection of Privacy Act, 2015, and is for the purpose of assessing a Human Rights Award nomination. If you have any questions regarding this collection or disclosure please contact the Administrative Officer of the Human Rights Commission by email at humanrights@gov.nl.ca or by phone at 729-2709 or 1-888-563-5808.