Lifetime Achievement Nomination Form

Description

Recognizing the long-standing contribution of exceptional OMSSA members who have recently retired or who plan on retiring ahead of next year’s OMSSA Exchange Conference.

More About the Lifetime Achievement Award

Nomination Deadline

September 12, 2025

"*" indicates required fields

Nominator Information

Nominators are asked to complete several questions before providing their nominee's information. OMSSA will contact nominators with any clarifying questions and once the Awards Committee has made their selections.

Name*

First Last

Email*

Phone*

Organization Name*

Position/Title*

Date*

Do you have sign-off from your Commissioner / Lead?*

(Nominators must receive sign-off from their Commissioner/Lead)

Yes

Please confirm your Commissioner / Lead*

(please type name)

Nominee Information

Name of Nominee*

Nominee's Organization*

Position/Title*

Email*

Phone*

Nominee's Start Date (year) to Retirement Date (year)*

Record of Achievement

*Please review eligibility criteria on our website and limit each response to 300 words or less

Please provide examples of the nominee’s active participation with the association, evidenced by at least two of the following: OMSSA networks; OMSSA task forces / working groups; standing committees; OMSSA’s Board of Directors; etc*

Please provide examples of the nominee’s representation of OMSSA on at least one external table, thereby making contributions to human services policy and implementation in Ontario*

Please provide examples of a meaningful contribution from the nominee that strengthened the association in one of the following areas: policy development; educational programs and events development; governance and sustainability; reputation with external stakeholders*

Please provide examples of a meaningful contribution from the nominee to the improvement of human service policy and implementation at any order of government*

Please upload a headshot image of the nominee*

Accepted file types: jpeg, jpg, png, Max. file size: 3 MB.

Please upload any additional documents to support your nomination

(this could include a resume, published report, video, etc.)

Drop files here or

Max. file size: 10 GB.

Name

This field is for validation purposes and should be left unchanged.