2018 HTNYS Trustee Leadership and Advocacy Award Call for Nominations

Healthcare Trustees of New York State (HTNYS) is proud to announce a "Call for Nominations" for its 2018 Trustee Leadership and Advocacy Award, which will be presented at HTNYS' Annual Conference on Saturday, September 15, at The Saratoga Hilton in Saratoga Springs.

Please complete this form to submit your nomination by June 26 (5 p.m.) to Healthcare Trustees of New York State. Thank you.

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* 1. Nominee information (Nominees cannot be a current member of the HTNYS Board of Governors):

Name

Facility

Home Address

City/Town

State

Zip code

Email:

Telephone:

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* 2. Nominator information (Nominators must be board chairs or chief executive officers):

Name

Title

Facility

Email Address

Phone Number

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* 3. Facility Contact Person:

Name

Title

Facility

Email Address

Phone Number

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* 4. How long has the nominated trustee served on the hospital or health system board?

fewer than four years

five to nine years

10 to 14 years

15 to 19 years

more than 20 years

Comments:

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* 5. Which positions has the nominated trustee held? (Check all that apply.)

Chair

Vice Chair

Secretary

Treasurer

Committee Chair (name which committees in comments section)

Other (please describe in the comments section)

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* 6. Leadership: Please describe one or two specific and noteworthy initiatives or challenges in which the nominee took a leadership role over the past several years. Explain the significance of the activity and its benefit to the organization and community.

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* 7. Advocacy: Describe the nominee's advocacy role in the community. Please focus on the nominee's commitment to the community and his or her role in promoting collaborative relationships and/or joint ventures with others in the community. Advocacy activities can include: healthcare policy-related issues at the local, state, or federal levels; and/or pressing issues of local concern to the healthcare organization and/or community.

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* 8. Please provide a summary of no more than 500 words of the nominee's leadership and advocacy roles on the board, and in your healthcare organization. Describe the qualities the nominee possesses that make him/her an extraordinary trustee.

2018 HTNYS Trustee Leadership and Advocacy Award Call for Nominations

Question Title

* 1. Nominee information (Nominees cannot be a current member of the HTNYS Board of Governors):

Question Title

* 2. Nominator information (Nominators must be board chairs or chief executive officers):

Question Title

* 3. Facility Contact Person:

Question Title

* 4. How long has the nominated trustee served on the hospital or health system board?

Question Title

* 5. Which positions has the nominated trustee held? (Check all that apply.)

Question Title

* 6. Leadership: Please describe one or two specific and noteworthy initiatives or challenges in which the nominee took a leadership role over the past several years. Explain the significance of the activity and its benefit to the organization and community.

Question Title

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* 8. Please provide a summary of no more than 500 words of the nominee's leadership and advocacy roles on the board, and in your healthcare organization. Describe the qualities the nominee possesses that make him/her an extraordinary trustee.

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* 9. Please describe the nominee's involvement in other community initiatives and how those relationships have assisted in his/her role on the board.

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* 10. Please include additional information you would like the review panel to know about this candidate.