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SHEVCHENKO MEDAL INDIVIDUAL NOMINATION FORM

The Shevchenko Medal is the highest degree of recognition that can be granted by the Ukrainian Canadian Congress.  It recognizes individuals, of Ukrainian and non-Ukrainian descent, groups and organizations for their outstanding National voluntary contribution, towards the development and enhancement of the Ukrainian Canadian community. DOCUMENTS YOU NEED TO FILL OUT THIS FORM: - Names of nominators - 5 major accomplishments of the nominee - Names of References and 2 Letters of Reference (PDF, JPEG)

Step 1 of 4

25%

NOMINEE INFORMATION

BEFORE YOU START, MAKE SURE YOU HAVE 1) INFORMATION ON THE NOMINEE'S ACCOMPLISHMENTS 2) NAMES AND ADDRESSES OF THE NOMINATORS AND REFERENCES FOR THE NOMINEE 3) REFERENCE LETTERS
Name
Address

NOMINEE INFORMATION CONT'D

Please indicate the category for which the individual is being nominated:(Required)

Accomplishments: Briefly describe five major achievements that the nominee has successfully attained

Background about the nominee, of no more than a total of 500 words, typewritten, must be included with this nomination form. It should include: - brief biographical data, - organizational memberships, - special recognition received by the nominee in the past - a description of the nominee’s accomplishments that validates their nomination for a Shevchenko Medal.

NOMINATOR INFORMATION

The application must be submitted by two nominating individuals OR one nominating organization. Names of two nominators are required to advance a nomination. Nominators must be members of a UCC member organization in good standing.
Nominator 1:
Address
UCC Member Organization has been notified(Required)
I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.(Required)
Nominator 2:
Address
UCC Member Organization has been notified(Required)
I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.(Required)
OR Nominating Organization – must be a UCC member organization in good standing.
Address
Name
I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.
Name
I hereby declare the information contained in this Nomination Application to be true to the best of my knowledge.
Max. file size: 256 MB.

References: Names of two references are required by the Jury Panel. References must be able to verify the accomplishments of the nominee

Referee 1:
Approval(Required)
Accepted file types: jpg, png, pdf, Max. file size: 256 MB.
Referee 2:
Approval(Required)
Accepted file types: jpg, png, pdf, Max. file size: 256 MB.

Forms, which do not have this information will be considered incomplete and will not be forwarded to the Jury Panel.

Would you like a copy of the form?

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  • Address: 130 Albert Street, Suite 500, Ottawa, Ontario K1P 1B1
  • Telephone: (613) 232-8822; Fax: (613) 238-3822

Latest News

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February 1, 2023 in News

UCC Affiliations

  • Ukrainian Canadian Foundation of Taras Shevchenko
  • Canada-Ukraine Foundation
  • Canadian Ethnocultural Council
  • Ukrainian World Congress

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