British Columbia Medal of Good Citizenship Nomination

The Medal of Good Citizenship recognizes individuals who have acted in a particularly generous, kind or selfless manner for the common good without expectation of reward.

Before you start

There is no time limit to complete this form
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If you have questions, see how to submit a nomination or contact us

By email: bchonoursandawards@gov.bc.ca
By phone: 250-387-1616

Important. False statements or misrepresentation facts may lead us to refuse a nomination or revoke an honour or award.

Disclaimer

This Web site is available solely for the convenience of the public. Users assume the risk associated with any transfer of information to the British Columbia Honours and Awards Secretariat and with any other use of this page. The Honours and Awards Secretariat has made all reasonable efforts to protect the confidentiality of the information you provide and to ensure that your electronic transactions with us are secure. However, the Honours and Awards Secretariat is not liable for any damages that may arise from interception, loss, theft or other action regarding your personal information while in transit.

Users are solely responsible for the accuracy of the information provided to the British Columbia Honours and Awards Secretariat via this service.

The British Columbia Honours and Awards Secretariat is not liable for any damage that may arise from any restriction, delay, malfunction or unavailability of the system and reserves the right to withdraw this service at any time without prior notice.

Privacy

You share responsibility for protecting your personal information. If you are using the online nomination service or fillable PDF forms in a public place (i.e. government information centre, library, educational facility or Internet café) please ensure that you:

- Clear your browser's cache and close down your browser.
- If you must leave, cancel the application by closing the window.
- Clear your browser's cache and close down your browser.
- When you print your nomination summary, be certain to collect all copies from the printer and keep in a safe place.
- Shred any copies that you do not need.

The information on this form is collected under the authority of the Provincial Symbols and Honours Act [RSBC 1996 c.380] and Section 26(c) and 27(1)(c) of the Freedom of Information and Protection of Privacy Act [RSBC 1996 c.165] and will help us to assess the eligibility and to notify recipients of the Order of British Columbia. By submitting this form you are: a) consenting to the collection of your personal information, if any, as disclosed on this form; and b) confirming that information disclosed on this form concerning any individual who has agreed to submit a letter in support of this nomination is either business contact information only or you have obtained the consent of the individual to disclose that individual's personal information, if any, on this form. If you have any questions about the collection, use or disclosure of this information, please contact the Honours and Awards Secretariat at (250) 387-1616 or by e-mail at bchonoursandawards@gov.bc.ca. Knowledge of a proposed nomination should be restricted to the individuals compiling the nomination.

Is your nominee eligible?

The nominee is not an elected representative or member of the judiciary who still holds office.

The nominee is not the same person as the Nominator (self-nominations will not be accepted).

The nomination is not for an act of bravery. (The medal is not awarded for acts of bravery).

For Bravery Awards, please see Canadian Bravery Awards or Governor General’s Decorations for Bravery.

Person being nominated

Prefix

First Name*

Last Name*

Postnominals

Please list any honours that are recognized by the Canadian Honours System and the highest academic degree achieved, as well as any recognition by the Crown (P.C., Q.C.)

Title

Organization

Address*

*Home address preferred for demographic purposes.

Street Address Address Line 2 City Province Postal Code

Phone*

Mobile

Email

Is your nominee a resident of British Columbia?

Yes
No

Specify residency

Date of Birth*

(YYYY/MM/DD)

If you don’t know your nominee’s year of birth, please enter 0000 and provide this information to us at your earliest convenience.

Is this a child or youth nomination (under 25)?

Yes
No

Short Description of Achievement (max 10 words)*

Do you believe this person self-identifies as First Nations, Métis or Inuit? (select all that apply)

Yes, First Nations
Yes, Métis
Yes, Inuit
No
Don't Know
Prefer not to answer

Do you believe this person self-identifies as racialized?

Yes
No
Don't Know
Prefer not to answer

Racialized people can have racial meanings attributed to them in ways that negatively impact their social, political, and economic lives. This may include people who identify as Arab, African, Black, Caribbean, Chinese, Filipino, Japanese, Korean, Latin American, Pacific Islander, South Asian, Southeast Asian, or West Asian.

British Columbia & Our Government Forms

Step 1 of 5 - Nominee Information

Before you start

Disclaimer

Privacy

Is your nominee eligible?

Person being nominated

Nomination Reasons

Nominator Information

Additional Testimonials

Submitting your completed application

Declaration