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YMCA Peace Medal
Nomination Form
About the YMCA Peace Medal
Peacemaker Nominees Information
“…Peace has many dimensions. It is not only a state
of relationships among nations. We cannot expect
to live in a world of peace if we are unable to live in
peace with those close to us – even those who differ
from us… The responsibility for peace begins with
each person, in relationship with family and friends,
and extends to community life and national
activities…” — YMCA Statement of Peace, World
Alliance of YMCAs, 1981
Category:
In every community there are people who make
a difference and who are committed to bringing
peace and prosperity to the world they live in, often
in the face of great conflict. We call these people
peacemakers because they have found innovative
ways to address social injustice within their local,
national or global community.
Youth (19 or under)
Title:
Mr.
Mrs.
Adult (20+)
Group
Ms.
Name:
Group/Organization Name (if applicable) :
___________________________________________
Mailing Address :
_______________________________apt. #:_______
City:________Province:_______Postal Code:
___
Phone Number:
The YMCA Peace Medal is a way to recognize and
celebrate these peacemakers who inspire us to join
them in creating a more peaceful community.
Email:
Nominations due October 21, 2016.
Title:
Peacemaker Selection Criteria
YMCA Peace Medal nominees should demonstrate
the values of PEACE:
Name:
P = Participation – getting involved and
encouraging
others to get involved in community-building
activities.
___________________________________________
E = Empathy – listening and understanding diverse
perspectives to create a sense of belonging for all.
A = Advocacy – making the case for positive
change in the community.
C = Community – building and strengthening
community connections and capacity.
E = Empowerment – inspiring others to foster
peace
and helping them gain the skills and tools to
succeed.
Nominator Information
Mr.
Mrs.
Ms.
Group/Organization Name (if applicable) :
Mailing Address :
_______________________________apt. #:_______
City:________Province:_______Postal Code:
___
Phone Number:
Email:
The YMCA Community
Breakfast for Peace
Wednesday, November 23, 2016
ymcaofoakville.org | 905-845-3417
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Nominatmmunity today!
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YMCA Peace Medal
Nomination Form
Nomination Submission Guidelines:
· Maximum of four pages to answer nomination questions.
· Maximum of two photos of the nominee in action.
Nomination will not be considered for the following:
· YMCA staff or Board members.
· Professionals who are paid to do peacemaking work.
· Self-nominations.
1. Why did you choose to nominate this individual/group and how have they inspired you and others
through their acts of peace?
2. Describe how this person/group is seeking innovative solutions to violence, conflict, discrimination,
injustice and community cohesion. Describe the work performed in specific detail.
3. What was the nominee’s role and responsibility in performing the above?
4. Please summarize the nominee’s impact on individuals and/or on our community in creating peace
(Please refer to the values of the PEACE acronym on page one.) Be as specific as possible, for example;
number of people involved, amount of time, list of outcomes, funds raised, etc.
5. Describe how any peace work initiatives create a long-term, sustainable impact on individuals or the
community?
6. Highlight any collaboration with other groups or individuals.
7. Highlight any challenges or obstacles the nominee faced and how they overcame them.
8. Is the nominee paid a salary for their peace keeping?
Yes
No
9. Are you (the nominator) and the nominee available to attend the YMCA Peace Breakfast or Peace Week
Award Ceremony on Wednesday, November 23, 2016?
Yes
No
10. How did you learn about the YMCA Peace Medal nominations?
Newspaper
School
Flyer
YMCA Website
Previous Winner
Facebook
Twitter
Other:
Community Group
Thank you for taking the time to recognize someone and for sharing their impact with us!
Please submit all YMCA Peace Medal nominations to the address below by October 21,2016.
Attention: Teresa Rinaldi,YMCA of Oakville, 410 Rebecca Street, Oakville, Ontario, L6K 1K7
[email protected] or fax: 905-842-6792