Nomination Forms

Deadline for Nominations: Closed

Individual Award Nominations
Five individuals will be selected for the award. To be considered for the award, the following requirements must be met.

Individual nominees must:

• Be a volunteer or a previous volunteer for a health-related, nonprofit organization
• Have made a passionate commitment to improving the quality of health in a Georgia community
• Be unselfish in contributing their time to community activities
• Serve as a role model and inspiration to others

Individual Award Criteria
(Please provide a response to all items and include the complete question with your response.)

1. Provide a detailed description of the nominee’s involvement as a volunteer in the community.
2. How would you describe the nominee’s commitment to addressing the health needs in their community?
3. Would you consider this nominee a role model or community leader? If so, why?
4. As a volunteer, what impact do you believe the nominee has had on the health of the community they serve?
5. What motivated you to nominate this individual?

The Nomination Process
Nomination Forms are available at the top of this page, or by contacting the Foundation at 404-653- 0990. They are not, however, required. Nominations must be typewritten and may be submitted via mail or email (connections2010@healthcaregeorgia.org), and include the following information:

1. Name, organization name(s), title (if applicable), address, telephone numbers and email address of both the nominator and nominee(s)
2. Answers to all Award Criterion requirements
3. Supplemental information that illustrates the nominees’ contributions to the community (news articles, pictures, brochures, etc.) (Optional)

All nomination materials submitted will become the property of Healthcare Georgia Foundation and will not be returned. Fax submissions will not be accepted.

Collaborative Award Nominations
One collaborative (comprised of three or more health-related Georgia nonprofit organizations) will be selected for this award. In order to be considered for the award, the following requirements must be met.

Collaborative nominess must:

• Be actively working together
  
• Represent partnership models working towards promising practices and results
  
• Show initiative and a deep commitment to addressing health-related needs of the community
  
• Demonstrate that the collaborative effort has been effective in improving the quality of health in a Georgia community
  
• Reflect diversity in its membership

Collaborative Award Criteria
(Please provide a response to all items, and include the complete question with your responses.)

1. Provide a detailed history and description of the collaborative effort. Include goals, objectives, partnerships, etc.
2. Describe the roles and responsibilities of the organizations involved.
3. What projects related to health and/or health care concerns does this collaborative address?
4. What impact has the collaborative had on the community? Be sure to include successes and specific results.
5. Does this organization reflect and represent the diversity of the community it serves?
6. Describe how the collaborative has been proactive in initiating change to promote better health outcomes in the community it serves.
   

The Nomination Process
Nomination Forms are available at the top of this page, or by contacting the Foundation at 404-653- 0990. They are not, however, required. Nominations must be typewritten and may be submitted via mail or email (connections2010@healthcaregeorgia.org), and include the following information:

1. Name, organization name(s), title (if applicable), address, telephone numbers and email address of both the nominator and nominee.
2. Answers to all Award Criterion requirements
3. Supplemental information that illustrates the nominees’ contributions to the community (news articles, pictures, brochures, etc.). (Optional)

All nomination materials submitted will become the property of Healthcare Georgia Foundation and will not be returned. Faxed submissions will not be accepted.