Nomination Form Checklist
Please check all included items (as required)

Please enter Nominee Biography in the below box.
(Should not exceed 300 words;anything exceeded will not be accepted)

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Nominee’s Information

All nominees must be African Canadian.

Please submit nominations as instructed under General Rules in the Nomination Package. Completed nomination forms must be received by email at the office of the Black Business and Professional Association no later than 4:00 p.m., Friday, January 19th, 2018. The selection committee will not consider late applications or applications submitted without a nomination form.

**Nominations will not be accepted by fax.

Please complete the following section with information about the nominee. Type or print clearly.

FIRST NAME
LAST NAME
MIDDLE INITIAL
AGE IN APRIL 2018 (Applies to age sensitive awards only - Validation of age required)
Street Address:
City, Province, Postal Code:
Telephone Number (incl. area code):
Fax Number (incl. area code):
Email Address:
Website:
Facebook
Instagram:
Twitter:
Please check the category or categories for which the individual is being nominated

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Nominee’s Information
Please complete the following section with information about yourself - the nominator. Type or print
clearly:
FIRST NAME
LAST NAME
MIDDLE INITIAL
Street Address:
City, Province, Postal Code:
Telephone Number (incl. area code):
Fax Number (incl. area code):
Email Address:
Please explain how the nominee has demonstrated excellence in the chosen category and why they are deserving of the award
I have obtained the nominee’s permission to submit this nomination:
How did you learn about the Harry Jerome Awards?
Format: (pdf,docx,doc,jpg,jpeg) 10 MB

For more information please contact the Black Business and Professional Association by phone at (416) 504-097 or by email
at hja@bbpa.org. Visit our website at www.bbpa.org

Please forward the completed Nomination Form and supporting materials to:

BY MAIL:
hja@bbpa.org

BY MAIL:
Black Business and Professional Association
180 Elm Street, Toronto, Ontario M5T 3M4

*Nominations will not be accepted by fax*

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