Canadian Hospice Palliative Care Association > About The Canadian Hospice Palliative Care Association > Awards > Balfour Mount Champion Award > Balfour Mount Champions Award – Nomination Form

Balfour Mount Champions Award – Nomination Form

  • Nominator

  • Nominee

  • Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, gif, png, , Max. file size: 64 MB.


  • Accepted file types: doc, docx, odt, pdf, rtf, tex, txt, wks, wps, wpd, jpg, jpeg, gif, png, Max. file size: 64 MB.


  • Balfour Mount Champion Award: Eligibility Criteria

  • Please ensure that the nominee meets the following criteria prior to submitting the nomination form for consideration by the CHPCA Board.

    The nominated individual, company or organization has fulfilled the following criteria:

    -Shows the qualities of being a national champion for hospice palliative care by engaging in collaboration and partnerships, influencing change, networking, and/or storytelling and communications efforts and initiatives.
    -Contributes to the advancement of hospice palliative care by demonstrating clear, compelling goals toward improving access, awareness, or leading advancements in hospice palliative care through the creation of innovative programs, and contributions to goals and standards for hospice palliative care.
    -Demonstrates knowledge in hospice palliative care in a way that promotes programs and services, research, education, and/or knowledge translation through education, innovation, and publishing.
    -Is a leading in hospice palliative care by demonstrating characteristics of being a role model, guiding, training, educating, and mentoring, and/or representing palliative care nationally.
    -Engages in public awareness activities and initiatives that promote hospice palliative care nationally and advance public policy.
    -Is a Canadian citizen or a company or organization that operates primarily in Canada;

    The candidate does not need to achieve all of the performance activities but must fulfil the spirit of the award criteria. A marking criterion determines the judging, and award recipients are chosen based on the highest marks earned for meeting performance guidelines as outlined below.

  • Presentation of Award

  • It is preferred but not required that the nominee is in attendance at the CHPCA Opening Ceremonies to accept the award if selected. The 2023 National Conference opening ceremonies takes place at The Ottawa Marriott Hotel on October 12th, 2023 beginning at 2:15 PM.

  • Nominee Background Information

  • Provide examples of how the individual, company, or organization has achieved the performance activity under each eligibility criteria area. N/A should be entered in the answer field if the nominee does not meet one of the performance activities.

  • Committed to Excellence: Contributes to the advancement of hospice palliative care by demonstrating clear, compelling goals toward improving access, awareness, or leading advancements in hospice palliative care in any of the following ways:

  • Knowledgeable: Demonstrates knowledge in hospice palliative care in a way that promotes programs and services, research, education, and/or knowledge translation in any of the ways described below:

  • A Dedicated Leader: Leading hospice palliative care by demonstrating the following characteristics:

  • This field is for validation purposes and should be left unchanged.
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