Unsung Hero Nomination Form

If you encounter any difficulties with this application form, please contact volunteer...crohnsandcolitis...ca

Your First Name*:	Enter your First Name
Your Last Name*:	Enter your Last Name
Your Email*:	Enter your email address
Your Phone Number*:	( ) - Second three digits Last four digits Enter your phone number
Your Role at Crohn's and Colitis Canada*:	Staff Member Volunteer Other
Nominee - First Name*:
Nominee - Last Name*:
Nominee - Email:
Province*:
Length of volunteer involvement with Crohn's and Colitis Canada*:	How long has the nominee been an active volunteer with Crohn's and Colitis Canada?
Nominee’s role and/or responsibilities at Crohn's and Colitis Canada*:	What has been the extent of their involvement i.e. frequent engagement, leadership role, committee involvement etc. (Max 500 characters including spaces)
Unique or special contributions including an overview of impact made*:	Highlight unique or special contributions, this can include community outreach, patient or administration support, volunteer engagement and/or fundraising. (Max 500 characters including spaces)
How did the nominee inspire and/or collaborate with others to make a difference?*:	Describe how this nominee inspired and collaborated with others. (Max 500 characters including spaces)
Upload file if there is additional information you wish to submit:	Upload a .pdf or .doc file containing any additional information to support your nomination.

Canada has among the highest incidence rates of Crohn's and colitis in the world.
1 in 140 Canadians lives with Crohn’s or colitis.
Families new to Canada are developing these diseases for the first time.
Incidence of Crohn’s in Canadian kids under 10 has doubled since 1995.
People are most commonly diagnosed before age 30.

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