Please select the award for which you are nominating an individual or team.
____ Integrated Rural Healthcare Award____ Outstanding Rural Health Practitioner Award____ Rural Health Achievement Excellence Award____ Rural Health Distinctive Consumer Advocate AwardNominee Name: _____________________________________________________
Address / City / State / Zip: ______________________________________________
Phone (Office): _______________________ (Home): ________________________
Nominee’s Organization: ________________________________________________
Areas (towns, counties) affected by Nominee’s Work: _____________________________
Please attach a description of the nominee’s contribution to rural healthcare, accomplishments and the significance of this person’s work. A biographical sketch should be attached. You may also attach news articles and other documentation to support this nomination.
Name of Person/Organization Submitting Nomination: ______________________________________
Address/City/Zip: _____________________________________________________
Email Address: _______________________________ Phone: __________________
Awards will be presented at the annual Nebraska Rural Health Conference in September.
Deadline for Nominations: August 21, 2009
**All applications must be postmarked by this date. Late nominations will not be considered for awards.**
Mail completed applications to:
Melissa Beaudette
Nebraska Rural Health Association
2222 Stone Creek Loop South
Lincoln, NE 68512
or email to mbeaudette@mwhc-inc.com
