NHCHW Coalition CHW & Stakeholder Award of Excellence

First, let's learn about you!

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* 1. Name:

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* 2. Email:

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* 3. Title/ Role:

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* 4. Organization:

Great! Now tell us about who you would like to nominate for the Award of Excellence!

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* 5. Their Name:

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* 6. Their Email:

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* 7. Their Title/ Role:

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* 8. Their Organization:

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* 9. Are you nominating them for the CHW of the Year or Stakeholder of the Year award?

Community Health Worker (CHW), this includes all similar roles! Outreach workers, community support specialists, community health representatives, etc...

Stakeholders, this includes all allies of CHWs! Providers, supervisors, trainers, organization or community leaders, policymakers, etc...

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* 10. Please explain why you are nominating this person for the award. What makes them excellent? For CHWs, tell us how they serve their community and how they contribute to the CHW workforce and/or their organization. For stakeholders, tell us how they support CHWs in their organization or statewide.
Give examples of their outstanding work!