Masonic Mission Award Nomination Form

Every day, the staff and providers of University of Minnesota Masonic Children’s Hospital and its clinics work to create the most positive experience possible for patients and families through their care and compassion. Here’s your chance to honor a staff member that you believe should be recognized for their hard work.

You can nominate a nurse, technician, medical assistant or anyone else who gave you exceptional care. Quarterly, Minnesota Masonic Charities, in partnership with the Masonic Children’s Hospital, will recognize a staff member with a “Masonic Mission Award,” to include a gift and your note of appreciation.

Please note: Only patients and families may nominate staff for this award. Nominations from staff members will not be considered.

Question Title

* 1. What is your name?

Question Title

* 2. What is the patient's name?

Question Title

* 3. What is the name of the healthcare provider (nurse, physician, tech, etc.) that you would like to nominate? If you know the first and last name, please provide both.

Question Title

* 4. In 1-2 paragraphs, please describe how this person provided exceptional care to the patient and/or family. Please be as detailed as possible.

Question Title

* 5. May we contact you if your nominee wins the award?

Yes

If so, please provide us with your preferred method of contact information.

Question Title

* 6. When you share my note of appreciation with the nominee,

I would like him or her to know my name

I would not like him or her to know my name

If you have any questions or comments, please contact Ann Shelp at 612-672-4698 or ashelp1@fairview.org