2025 AHHC Carolyn Cusic Professional of the Year Award Form

2025 AHHC Carolyn Cusic Professional of the Year Award - Nominee Profile Form

Criteria for the Award:
The nominee may be, but is not limited to: a registered nurse, therapist, social worker, pharmacist, Qualified Developmental Disability Professional, Qualified Mental Health Professional or clergy who has worked in home care, home health, and/or hospice for a minimum of three years. This award is intended to recognize the clinical professional in a direct care and/or mid-level management role.

Do not use the name of the nominee or any identifying information (such as agency name) on your narrative or in your answers. Please do not skip any questions or your nomination will be disqualified.
1.Name of Nominator(Required.)
2.Nominator's Agency(Required.)
3.Nominator's Email(Required.)
4.Nominator's Phone Number(Required.)
5.Nominee's Agency Name(Required.)
6.Nominee's Name(Required.)
7.Nominee's Title and Credentials(Required.)
8.Nominee's Email Address(Required.)
9.Number of Years in Home Care, Home Health, or Hospice(Required.)
10.List the committees that this individual has either developed or served. Indicate any office or other position of committee leadership, noting signifiant accomplishments. Indicate the agency, such as AHHC or other industry-related organizations (100 words or less).(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
12.List community activities and organizations the nominee has participated in which home care, home health, or hospice care was the main focus of the nominee’s involvement (100 words or less)(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
14.Describe the nominee’s efforts to enhance their own professional growth. Include all formal education, workshops and continuing education with CEUs. (100 words or less).(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
16.Describe the nominee’s efforts to enhance the growth of their employer. (100 words or less).(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
18.List the positions held by the nominee by agency with years of service.(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
20.Prepare a narrative of no more than 250 words about how the nominee demonstrates excellence and commitment to job performance and patient care. Provide specific examples of innovations, professional skill, and leadership.(Required.)
Remember: Do not use the Nominee’s name or agency in your response.
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