2021 Grace Diaz Blue Light Award Nomination Form

Each year the Rhode Island World Diabetes Day (RIWDD) Committee recognizes an individual or organization that has positively impacted diabetes in the state of Rhode Island by awarding the Grace Diaz Blue Light Award. In keeping with the international theme of World Diabetes Day 2021, "Access to Diabetes Care," this year's Blue Light Award will be presented to an individual or organization who has gone above and beyond in providing diabetes care. The criteria for the nominee is a commitment to the health and well-being of people living with chronic disease, being a role model for others and exhibiting a devotion to improving the health of the community. Please complete the form below to place your nomination for a deserving person/organization to be considered for this award.

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* 1. Name of Person/Organization you are nominating:

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* 2. Email of nominee:

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* 3. Phone number of nominee:

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* 4. Please provide a description of the person/organization you are nominating and how this nominee has met the criteria noted above:

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* 5. What is unique about this person/organization in their role?

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* 6. How has this person/organization advocated for patients during the COVID-19 pandemic?

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* 7. How has this person/organization influenced diabetes and/or pre-diabetes in Rhode Island?

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* 8. Your name:

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* 9. Your email address:

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* 10. Your phone number:

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