Honorary Member / Membre d’honneur

CAG Honorary Member
ACG Membre d’honneur

Nomination Form
Formulaire de proposition
Before beginning this nomination form, please have ready to upload the nominee's CV/resume in PDF (preferred) or Word format. You will be asked to upload this file below.

Please also have prepared the names and contact information for the two referees providing letters of support.

You will be given the option to upload your signed letter of nomination and/or letters of support in PDF format; or, you may send these letters by regular mail to the address indicated at the end of this form. Electronic submissions are preferred.

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Avant de commencer à remplir ce formulaire de proposition d’une candidature, soyez prêt à téléverser le CV du candidat en formats PDF (de préférence) ou Word. On vous demandera de le téléverser plus loin.

Veuillez aussi avoir sous la main le nom et les coordonnées des deux répondants qui ont rédigé les lettres de soutien.

Vous aurez la possibilité de téléverser votre lettre signée de proposition d’une candidature et/ou les lettres de soutien en format PDF; vous pouvez également envoyer ces lettres par la poste à l’adresse indiquée à la fin de ce formulaire. Le mode d’expédition de prédilection est la voie électronique.
Information about Nominee
Name:*

First NameLast Name
Telephone:*

Area CodePhone Number
Fax:

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:*
Division(s):

Educational GerontologyHealth & Biological SciencePsychologySocial Policy & PracticeSocial Sciences
Consent*

The candidate consents to being nominated.
Information about Nominator
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone:*

Area CodePhone Number
Fax:

Area CodePhone Number
E-mail:*
Division(s):

Educational GerontologyHealth & Biological SciencePsychologySocial Policy & PracticeSocial Sciences
Letter of Nomination
Please upload your signed nomination letter (PDF format only). Or, you may submit your nomination letter by regular mail to the address at the end of this form.

Upload a File

Cancelof
Letters of Support
Please provide the names and contact information for the two referees providing letters of support for this nomination. You may upload the signed letters of support (PDF format only), or you may submit the letters by regular mail to the address at the end of this form. Electronic submissions are preferred.

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Veuillez donner le nom et les coordonnées des deux répondants qui ont rédigé les lettres de soutien pour cette candidature. Vous pouvez téléverser les lettres de soutien dûment signées (en format PDF seulement) ou les envoyer par la poste à l’adresse indiquée à la fin de ce formulaire. Le mode d’expédition de prédilection est la voie électronique.
Letter of Support (1 of 2)
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone:*

Area CodePhone Number
Fax:

Area CodePhone Number
E-mail:*
Please upload Letter of Support #1 (PDF format only)

Upload a File

Cancelof
Letter of Support (2 of 2)
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone:*

Area CodePhone Number
Fax:

Area CodePhone Number
E-mail:*
Please upload Letter of Support #2 (PDF format only)

Upload a File

Cancelof
If you wish to submit letters by regular mail, please send them to:

Canadian Association on Gerontology
c/o Dept of Occupational Science & Occupational Therapy
University of Toronto
160 - 500 University Avenue
Toronto, ON M5G 1V7

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Si vous désirez expédier vos lettres par la poste, veuillez les adresser à :

L’Association canadienne de gérontologie

c/o Dept of Occupational Science & Occupational Therapy
University of Toronto
160 - 500 University Avenue
Toronto, ON M5G 1V7
Nominee's CV/Resume
Please upload the Nominee's CV/resume (PDF [preferred] or Word format)*

Upload a File

Cancelof
To submit your nomination, please click "Submit". You will receive an automated confirmation email. If you do not receive your confirmation email, please contact us.

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Pour soumettre votre proposition de candidature, veuillez cliquer sur « Soumettre ». Un courriel de confirmation vous sera automatiquement adressé. Si vous ne recevez pas ce courriel de confirmation, veuillez communiquer avec nous.
Should be Empty:

Information about Nominee

Information about Nominator

Letter of Nomination

Letters of Support

Letter of Support (1 of 2)

Letter of Support (2 of 2)

Nominee's CV/Resume