2021 KPHA Award Nominations Form - Special Service Award

Please take a few minutes to submit your nomination for the 2021 KPHA Special Service Awards using this electronic Award Nominations Form.

Two special service awards may be given annually, one of which may be to a non-member of KPHA. If you would like to submit more than two names for this award category, please clink on the original link to access this form as many times as needed.

Special Service Awards are for individuals who have rendered outstanding service to Kansas in the interest of public health and/or environmental improvement, including outstanding work in the area of COVID. For this award consider individuals and/or companies/organizations. Individuals can include public health workers at the state or local level, policy makers, public health nurses, Community Health Workers, health educators, social workers, or others who have rendered outstanding service.

If you have any questions, please contact Daniel Craig at 785-452-4848 or dacraig@srhc.com.

Nominations must be received by Friday, August 6th, 2021 for the September 2021 KPHA Conference.

Question Title

* 1. Contact information for KPHA member submitting nomination

Question Title

* 2. Contact information for Special Award Nominee #1

Question Title

* 3. Briefly describe how Nominee # 1 meets the selection criteria for this award and your reasons for nominating this individual to receive this award.

Question Title

* 4. Contact Information for Special Award Nominee #2 (leave blank if only submitting one name for nomination)

Question Title

* 5. Briefly describe how Nominee # 2 meets the selection criteria for this award and your reasons for nominating this individual to receive this award (leave blank if only submitting one name for nomination).

T