Cobb2020 Health Partnership & Cobb Chamber of Commerce 2018 Health Hero Award

2018 Health Hero Nomination Form

Purpose: The Cobb2020 Partnership for Health and the Cobb Chamber of Commerce seek to recognize qualified individuals and agencies that through outstanding and dedicated service have made significant positive impact on the health of our community. This award gives recognition to significant and innovative activities and accomplishments by an individual or organization.

Instructions: To nominate a person or business for this award, please complete each area of this form. If an area does not apply, please state “N/A”. You may attach additional information but please limit to no more than 3 pages. Note: Incomplete applications will not be considered.

Nominees must meet the following conditions:
1. Provide health and wellness services and/or support health issues in Cobb County.
2. Currently live or work in Cobb County.
3. Membership in the Cobb Chamber of Commerce is required for awardees. For more information on membership, visit www.cobbchamber.org.

Questions may be directed to Jazmyn McCloud, Cobb Chamber Health and Wellness Committee Member at jazmyn.mccloud@dph.ga.gov or 770-319-4716.

All nominations for the 2018 Health Hero Award must be received no later than 5:00pm November 9th, 2018.

One person and one business will receive the Health Hero award during First Monday Breakfast in December.

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* 1. Would you like to nominate a person or an organization?

A person

An organization

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* 2. Nominee Information

Nominee Name:

Address:

City:

State:

Zip Code:

Main Contact Person (if nominating an organization):

Phone number:

Email:

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* 3. Describe the Nominee's related field of work.

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* 4. Describe why the Nominee should be the recipient of the Health Hero Award. How has the nominee impacted the health of the community or local businesses.

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* 5. What innovative or significant activities or programs has the Nominee contributed to in 2018?

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* 6. [Optional] Additional Comments:

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* 7. [Optional] Upload attachments:

Please limit attachments to 3 pages. File size limit is 16MB.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 8. Nominator Information

Nominator Name:

Organization:

Address:

Phone:

Email: