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 Civic Award Nomination form

 Certificate of Achievement form

Civic Recognition Award

Please fill out the form below to submit.  This page is encrypted to greatly ensure that your submission remains confidential over the Internet.  Suggestions can be made anonymously for consideration. However, if you want a reply from the City then we require that you fill out your full name, address and phone number.


Provide your name, address and phone number:

Name of Nominator:
Contact No. of Nominator :
Nominator Address:
Nominators Email address:

Provide Nominee Name, Address and Phone Number:

Name of Nominee:
Contact No. of Nominee :
Address of Nominee:
Nominee Email address:
Award Category
  Adult Civic Recognition
  Youth Civic Recognition
  Group Civic Recognition

Please provide a letter (Not exceeding 1000 Words) outlining the nominee's lifetime or current year service through their involvements as follows :

Adult Civic Recognition Award Presentation
- participation in clubs, associations or volunteer organizations;
- any notable act or accomplishment in support of community service;
- any notable accomplishment or in his/her profession; and
- how the nominee has served as an ambassador for the community of Yorkton.

Youth Civic Recognition Award Presentation
- civic involvement and interests in clubs, associations or volunteer organizations;
- any notable act or accomplishment in support of community service;
- any notable accomplishment or in his/her profession; and
- how the nominee has served as an ambassador for the community of Yorkton.

Group Civic Recognition Award Presentation
- civic involvement and/or partnership with clubs, associations or volunteer organizations;
- any notable act or accomplishment in support of community service
- any notable accomplishment thru service and/or events the group has conducted in or for Yorkton; and
- how the nominee has served as an ambassador for the community of Yorkton.


Printable Version of the Nomination form can be downloaded here.

**Disclaimer: Information received will be kept in a confidential City Recognition Committee Award file and be destroyed after seven (7) years as per the Records Retention and Disposal Bylaw No. 42/2003. The information collected will be used to select award winners and to contact nominator and nominees as required.