Manitoba Cooperative Awards 2016 Nomination Form

The Manitoba Cooperative Awards is a program of the Manitoba Cooperative Association.

Nomination and Selection
Manitoba Cooperative Award winners are selected based on the information provided on the nomination form. Nominations should include clear and comprehensive information and appropriate details according to the nomination category. Applications may be rejected if the nomination process is not followed as outlined in the nomination form.
Award recipients will be selected by a Selections Committee representing the Manitoba Cooperative Association. All nominators will be notified by letter when award recipients have been selected. The names of other nominees will be kept confidential.
Additional Information

1. 
   Any registered Manitoba cooperative or credit union may submit a nomination for a Manitoba Cooperative Award. An authorized officer of the nominating co-op or credit union must sign the nomination form to affirm support for the nomination and the information contained in the form.
   

2. 
   The nominee, or an official of a nominated cooperative, must sign the nomination form to give consent and to let their name stand for nomination.
   

3. 
   For individual nominations, please submit a 4”x6” photograph of the nominee with the completed nomination package. This photograph will be used in the Awards Banquet Program if the nomination is successful. Successful organization nominations will be required to submit a high resolution electronic version of their logo for inclusion in the Awards Banquet Program.
   

4. 
   It is the responsibility of the nominator to work in association with the nominee to ensure that the information is complete and provides the details needed for a committee of strangers to evaluate the contributions. For example, when completing the nomination form general statements such as “spent many years on the board” or “made many contributions” say little of value. Instead, provide more detailed and measurable information, such as “served on the board of Co-op X for 10 years, 2 as secretary and 6 as president” or “proposed and led the successful negotiations to amalgamate Co-ops X, Y and Z. Within 5 years their combined membership increased from 650 to 1100, and annual sales from $1.5 million to $4.6 million.” As much as possible, please separate events and achievements, and please use bullet points instead of lengthy narrative.
   

5. 
   Nominators may forward more than one nomination in any given year, provided that each nomination relates to a different individual or project.
   

6. 
   To be eligible to receive an award for the current year, a completed nomination form must be submitted during that year. Nominations from previous years are eligible for resubmission on the following years nomination form.
   

The deadline for receipt of completed nomination forms is May 15, 2016. Mail or email (with scanned signatures) the nomination to:
Manitoba Cooperative Association

Main floor - 317 Donald Street

Winnipeg, MB R3B 2H6

info@manitoba.coop
For further information or to receive additional nomination forms, please contact the Manitoba Cooperative Association at the address listed above or by phone at (204) 989-5930.





Please Indicate Award Category

(one per nomination)

Nominee’s Name (individual or organization)      

Address      

Phone (home)       Phone (business)      

Email       Fax      

Affiliated with this cooperative or credit union      

Nominee’s Acceptance

I have read the information contained in this nomination package and certify it to be true and correct. I allow my name to stand for nomination. If my nomination is successful, I consent to the publication of my photograph, information from my nomination package and any audio/video recording used in conjunction with this event.

Nominee Signature Date      
Nominating Cooperative or Credit Union      

Authorized Officer       Position      

Address      

Phone (home)       Phone (business)      

Email       Fax      

Nominator Information

I, the undersigned, take pleasure in making this nomination on behalf of the cooperative or credit union I represent, and believe the information provided is complete and correct.

Nominator Signature Date      

Supporting documents (e.g. letters of support) may be attached to these sheets.

If additional space is required, additional pages may be attached to this nomination, but please provide additional information in the same format as the form. Information should be provided in point form wherever possible with dates and years of service in various positions provided.

A. Cooperative Organization Contributions

1. Contribution through Membership Support

Please list the names and dates of all the cooperatives in which the nominee has held a direct membership:

Organization	Dates – Number of years	For Office Use Only
For example: Red River Credit Union	1980 – present 29 years
     	     
     	     
     	     
     	     
     	     

2. Contributions Through Volunteer and/or Employee Positions

Please list all the positions held within cooperatives and/or credit unions at the local, regional and national level. Volunteer Positions include: delegate, board member, executive officer, and president. Employee positions include: employee, head – area/department, trained specialist/consultant, and manager/CEO. Please note if the nominee was a founding/charter member of a cooperative or credit union.

Cooperative Organization	Position Held	Dates – Number of years	For Office Use Only
Local Level Involvement
For example: Winnipeg Co-op	Director Vice-President	1981-95  14 yrs 1984-87  3 yrs
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
Regional Level Involvement
For example: Federated Cooperatives Limited	Delegate Resolutions Committee	2000-05  5 yrs 2004-05  2 yrs
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

Cooperative Organization	Position Held	Dates – Number of years	For Office Use Only
National/International Level Involvement
For example: Canadian Cooperative Association	Delegate	1980-1988  8 yrs 2000-2006  6 yrs
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

3. Successfully Implemented Contributions

Please list the most significant contributions the nominee made to help build, maintain or improve a cooperative organization or the cooperative community. What roles did the nominee play and what outcomes resulted?

Significant Contributions to a Cooperative Organization	Role of Nominee	Outcomes for the Organization & Community	For Office Use Only
Local Level Involvement
For example: Opened a new co-op grocery branch	Participant on Board while approving expansion plans	Increased sales by $2 million 10 new jobs in the community 300 new co-op members	A	B	C
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
Regional Level Involvement
For example: Formed a co-op (or federation/association) of communication co-ops)	Introduced the idea and was the primary leader	Created purchasing power for all communications co-ops Increased government relations for the sector	A	B	C
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
Significant Contributions to a Cooperative Organization	Role of Nominee	Outcomes for the Organization & Community	For Office Use Only
National/International Level Involvement
For example: Implemented new governance model for Canadian Worker Cooperative Federation (CWCF)	Introduced idea while on the Board of CWCF	Better delegate structure allowing more regional representation Increased participation from members	A	B	C
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

B. Other Community or Volunteer Contributions

Provide details that demonstrate the nominee’s support for community and involvement in volunteer service. Include the number of years of service and the contributions made for each community organization listed.

Organization	Roles/Contributions	Years of Service	For Office Use Only
For example: Winnipeg Chamber of Commerce	Member On the Board of Directors	40 years 4 years
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

Cooperative Achievement Award Nomination

New Cooperative or Credit Union Venture(s)

In point form, provide details of innovative projects or business initiatives that demonstrated increased leadership and renewed commitment to cooperative values, principles or the co-op model. Highlight the improved social and economic benefits to members and explain how this has been of significant benefit or value to the community.

Innovative Project or Business Initiative	Benefits to members	Value to the Community	For Office Use Only
For example: 3 different established worker co-ops implementing a joint marketing plan that included the promotion of what a co-op is and what makes a co-op different from other businesses, illustrating the cooperative principle cooperation amongst cooperatives	Members of the various worker co-ops have the opportunity to work together and pool resources Increased sales, therefore increased return to members	Increased marketing resulted in more awareness within the community of what a co-op is and the benefits of using a co-op
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

Outstanding Achievements

Provide details or examples that demonstrate your cooperative or credit union’s achievements. Highlight how your cooperative or credit union created and implemented solutions that improved benefits to members, the community or the sector.

Achievement	What was done to achieve this?	Benefits to members, community or sector	For Office Use Only
For example: The co-op was listed number 49 in the top 50 employers in Manitoba	The co-op developed an employee incentive program. The co-op held retreats for employees to build morale. The co-op allowed staff to volunteer in community organizations for a day without having to take a vacation day.	A more productive workforce resulted higher member satisfaction. Increased involvement of co-op staff members as volunteers in the community.
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     
     	     	     

Community Involvement

List activities that demonstrate your cooperative or credit union’s support for community. Highlight how a community need was met and the impact this had on the community.

Activity	Impact on the Community	For Office Use Only
For example: The co-op promotes the Cooperative Youth (CY) Leadership Program and sponsors students from the local school to attend the CY Seminars	Provided an opportunity for youth to participate in a worthwhile program Increased community awareness about co-ops
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     
     	     

Additional Comments	For Office Use Only
     
     
     
     
     
     
     
     
     

Youth Leadership Award Nomination

Youth Contributions (for individual youth nominees)

In point form, briefly describe the contributions of the nominee that had significant impact on building, maintaining or improving a successful cooperative and the impact of that cooperative in the community.

Contribution	Impact on the Cooperative		Impact on the Community	For Office Use Only
For example: Was a founding member of XYZ co-op	The co-op would not have been created without this individuals leadership		XYZ co-op is the only organization in the community providing their service.
     	     		     
     	     		     
     	     		     
     	     		     
     	     		     
     	     		     
     	     		     
     	     		     
Youth Mentorship Contributions (for non-youth nominees and/or organization nominees) List the contributions of the nominee that have engaged, supported and mentored youth in their success as young cooperative leaders.
Contribution		How the contribution engaged, supported and mentored youth		For Office Use Only
For example: A credit union creates an in-school branch for students		Encouraged students to become members at a young age Had students sit on the Board of Directors of the credit union Had students employed in the branch
     		     
     		     
     		     
     		     
     		     
     		     
     		     
     		     
     		     
     		     

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