2017 Wheels of Change Awards - Nomination Form
Each year, Share the Road recognizes the impactful work of advocates and professionals across Ontario with our Wheels of Change Awards. These awards recognize leadership, innovation and relationship building in cycling. Award recipients are nominated by their peers and selected by the Share the Road Board of Directors. This year, the recipient will be recognized at the 9th Annual Ontario Bike Summit on April 11th and April 12th, 2017 (Chelsea Hotel, Downtown Toronto)*.

Please use this form to nominate people and organizations who have helped to change the cycling conversation in your community and/or Ontario. Nominations can be made under three categories: professional, organization and community champion/individual. You can submit multiple nominations.

All submissions must be received by midnight on Friday, March 10th, 2017. Thank-you in advance for your submission!

If you have questions, or problems with this form, please contact events@sharetheroad.ca.

All nominees will be notified that they have been nominated, regardless of whether or not they are selected for an award. Unless you indicate otherwise, we will let the nominee know the name of the person/organization that nominated them.

Please note that some of your comments may be shared with the nominee at the award ceremony and/or in writing when they are notified about their nomination.


*Nominees will not be excluded from consideration if they are unable to attend this event.

General Nomination Information
Your Name *
Your answer
Your Email Address *
So that we can touch base with any questions
Your answer
Your Phone Number (optional)
So that we can touch base with any questions
Your answer
Name of Nominee *
Your answer
Nominee Contact Information *
Phone or Email
Your answer
What is your relationship to the nominee? *
Your answer
Is this Nominee a Professional, Organization or Community Champion/Individual? *
Why is this professional/organization/community champion being nominated? *
Select all that apply
Required
Please provide details on the work/achievement for which this organization/individual is being nominated.
Where did the work/accomplishment take place? *
Your answer
When did the work/accomplishment take place? *
Your answer
What provided the motivation or impetus to do this work? *
Your answer
Give a brief description of the work and the role that the individual/organization played. *
Your answer
Describe any challenges that had to be overcome and how this was done. *
Your answer
What have the outcomes and impacts of this work been? *
Your answer
Why do you think this individual/organization is deserving of recognition? *
Your answer
Additional comments about the nominee (optional)
Your answer
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