2021 NCHN Awards: Nomination Form
Please submit no later than March 5, 2021.
Applications received after this date will not be considered.
Enter information as it should appear on all printed materials and award.
Name of Nominee
Nominee's Email Address
Organization's Web Address
Number of Years Active
For nominations of Individuals: enter the number of years as network leader.
For nominations of organizations: enter the number of years the organization has been in existence.
Area(s)/State(s) affected by the Nominee's work
The Outstanding Network Leader
The Outstanding Health Network
The Outstanding Emerging Network Leader
Friend of NCHN
Lifetime Achievement Award
If your nominee is chosen, you will be asked to contact the honoree upon winning and be the central communications for the honoree.
Name of Nominator
NARRATIVE & DOCUMENTATION
Please note that each nomination must include a written narrative, no more than 600 words, about why the person or organization being nominated should be considered for the selected award. This narrative is the primary instrument on which the nomination will be judged and should be based on the criteria listed within each award category, which is described in the Awards Program Guidelines.
Please include the significance of the nominee’s work within their network, community, state, and/or NCHN. If your nominee is chosen, your written description will be used at the annual Awards Presentation. The description should include those attributes that set this nominee’s work apart from others in their field. For example: demonstrable lasting change in health status, innovation or creativity, impact as demonstrated by replication or community acceptance, or ongoing influence in health network improvement.
A resume or CV may also be included for the nominations of individuals and does not count toward the 600 word limit.
NOTE: Your nominee is competing against others. The committee will use the written description and information submitted in this nomination form in making its decision. Please be very specific about why your nominee should be chosen.
This is required. If you are uploading your narrative as a document, enter "See attachment" and attach your document below.
Optional: Add your Narrative as an attachment
You may attach your narrative if you have saved it as a Word document or pdf
Attachments which enhance and support the award entry may be included. Supporting letters are encouraged and are limited to two (2). Letters should address the factors to be considered as outlined in the Awards Program Guidelines. Please note that it is not necessary to include documentation to be considered for the award.
Supporting Documentation 1:
Supporting Documentation 2:
Photo of the Nominee (optional):
Before submitting your entry,
please make sure that you have entered a complete description to support your nomination. This helps the Committee evaluate the nominations. The evaluations are based in large part on your nomination, so please be as thorough as possible.
After entering your signature below and submitting the form, you will be redirected to the 2021 Annual Educational Conference website and will receive a confirmation email which includes your entry.
Thank you for your assistance in recognizing excellence in health networks!
Questions should be sent to firstname.lastname@example.org
Enter your name to electronically sign the nomination