Required fields are marked with asterisks (*)

Brockton Good Neighbour Award

For an individual who has displayed activities that embody a strong sense of values, promoting the positive impact of good neighbourly deeds and contribute to the vitality and fabric of the community.

Eligibility:

Nominees must be a resident of Brockton.
A merchant or service provider who has gone above and beyond the norm in looking after the people they serve in the community.
An individual who goes out of their way, possibly on a continuous basis, to assist seniors, particularly those who are vulnerable financially or for health reasons.
An individual who has a good natured, outgoing personality who makes the lives of those they encounter daily, a little more enjoyable.
An individual who rallies the community for a cause important to the community or member of the community.

Criteria:

Nominees for this award should be someone who has taken the initiative to do spontaneous or unheralded deeds, rather than participation in group activities such as those with community groups or associations that result in Brockton being a more enjoyable community to live in. Activities must embody a strong sense of values, promote the positive impact of good neighbourly deeds and have contributed to the vitality and fabric of our community.

Deadline:

The deadline for nominations is May 26, 2025 at 4:30 p.m.

Volunteer Recognition Event:

Nominees will be invited to attend the Municipality of Brockton's Volunteer Recognition Event on June 12, 2025 from 5:00 to 7:00 p.m. at the Walkerton Community Centre (290 Durham Street West, Walkerton).

Nominator Information

Please enter the following information about the Nominator submitting the Nomination Form.

Name of Nominator:

Full Address of Nominator (Including Street, Town, Province, and Postal Code for contact purposes)

Telephone Number (For contact purposes):

Email Address (For contact purposes):

Note: Please note that the awards do not recognize individuals for personal successes or professional achievements. Nominations by or for Municipal Councillors and Staff members, by immediate family members, self-nominations, and posthumous nominations will not be accepted.

Nominee Information

Please enter the following information about the Nominee being nominated for the award.

Name of Nominee:

Full Address of Nominee (Including Street, Town, Province, and Postal Code for contact purposes)

Telephone Number of Nominee (For contact purposes):

Email Address of Nominee (For contact purposes):

Please describe the Nominee's volunteer activities and duration as a volunteer in the community of Brockton:

Please provide a brief description of the contributions that the Nominee has made to the community of Brockton:

Please describe why the Nominee should be chosen for this award.

Note: The Nomination Form will be submitted to the Municipality of Brockton's Volunteer Recognition Award Committee for review. The Nominee's name may be included in the Municipality of Brockton's Volunteer Recognition Event Awards Ceremony.

Information about the awards presented, including the names and photos of the award recipients, will be published of the Municipality of Brockton’s website and social media. Recipients are asked to inform the Municipality of Brockton if they do NOT wish to have their name or photo published.

Do you want to have your name or photo published by the Municipality of Brockton?

Yes

Signature of Nominator

Clear

Date: