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Community Health Hero Nomination Form

Icon: Community Health HeroMunson Healthcare recognizes individuals and organizations in our community who contribute significantly toward improving the health and wellness in the communities we serve. These are our Community Health Heroes.

Factors that go into the recognition include programs and services that:

  • Improve access to care. 
  • Address the unmet health needs of the uninsured, underinsured and disenfranchised. 
  • Address the unmet or emerging health issues of the youth and elderly. 
  • Focus on chronic disease prevention and management. 

Please complete the following form to nominate your Community Health Hero. Our Community Health Committee will review all nominations and select the award recipients that best meet the criteria listed above.

 

 

Nominee Information

Name (individual or organization)  *Primary Contact  *Address  *City  *County  *Phone  *Email  *

Nominated by:

Name  *Organization  *Address  *City  *County  *Phone  *Email  *

Nomination Criteria

Please choose the criteria that best describes your nominee's impact on your community.  *

Please describe your nominee's contribution to improving health and wellness in their community and why are they your Community Health Hero.  *