Current Page 1 Page 2 Preview Personal information on this form is collected under the authority of Section 31(c) of the Freedom of Information and Protection of Privacy Act and will be used for the purposes of assessing nominations and determining the recipient of the award. If you have any questions about this collection of personal information, you may contact the Innovation PEI Office by telephone at 1-800-563-3734 or by email at innovation@gov.pe.ca. Identification Enter nominator information in the fields below. First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example: C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Nominee Information First Name Last Name Preferred Pronouns Address City, Town, or Community Postal Code For example C1B 0X1 or 12345 Telephone Number For example 902-555-5555 Email Address Is the nominee an Indigenous person? - Select -YesNoPrefer not to say First Nation/Band Name Is the nominee a person of colour? - Select -YesNoPrefer not to say Is the nominee a person with a disability? - Select -YesNoPrefer not to say Does the nominee identify as LGBTQ2? - Select -YesNoPrefer not to say Website (if applicable) Social Media Accounts (if applicable)