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Beacon "Inspire" Associate of the Month Nomination Form
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1.
What entity does your nominee for Associate of the Month currently work for?
(Required.)
Beacon Corporate Services
Beacon Medical Group
Elkhart General Hospital
Memorial Hospital (includes Beacon Granger Hospital and Epworth Hospital)
Bremen Community Hospital
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2.
Please enter the name of the Associate you are nominating.
(Required.)
First Name
Last Name
Location/Dept/Floor
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3.
Please provide your name as the nominator.
(Required.)
First Name
Last Name
Enter your Location/Dept/Floor
Employee Number
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4.
Beacon Values
Compassion, Integrity, Respect, Trust
Please select at least one value you feel your nominee consistently demonstrates. Please provide examples and details from
your experience working with the Associate and or observing
the Associate. Please share specific reasons why you feel this Associate has demonstrated the chosen value(s).
Example:
"I'll never forget when he/she..."
"It really impressed me when ..."
"I felt that he/she truly cared when I saw him/her..."
(Required.)
