Nomination Form

Do you have questions about nominating a Community Star? Would you like to review an example of a Community Star story? Please visit PowerofRural.org to review our 2020 FAQs and review the 2019 book of Community Stars!

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* 1. Nominator Contact Information

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* 2. Which best describes the individual or organization you are nominating?

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* 3. Community Star Nominee Contact Details
(If nominating an organization please complete the information for the point of contact at the organization.)

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* 4. Please describe your connection to the individual or organization you are nominating.

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* 5. Please explain the individual’s or organization’s connection to or interaction with their State Office of Rural Health. (If you are unsure, please indicate that in your response.)

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* 6. The Community Star Recognition Program is designed to honor those whose contributions are making a difference in rural through collaboration, education, innovation, and communication. What do you believe to be your nominee’s “star” qualities? Provide examples of how your nominee demonstrates these qualities in their work and service.

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* 7. The 2020 Community Star Selection Committee will review and evaluate nominations, making recommendations for which stories to include in this year’s book and other NRHD activities based on the following merits. Please review these and select all that apply to your nominee. 

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* 8. Describe in as much detail as possible, examples of your nominee’s work and accomplishments that correspond with your selections to Question #7. 

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* 9. I can confirm that the individual or organization is making a difference in rural through collaboration, education, innovation and communication, and is located, working, or volunteering in a designated rural area.

Determine whether your nominee is considered rural using this Am I Rural? Tool

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* 10. I can confirm that I have notified the nominee of their nomination, and the nomination will be accepted.

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* 11. Is the individual or organization a HRSA, Federal Office of Rural Health Policy, Community-Based Division Grantee?

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* 12. How did you learn about the 2020 Community Star Recognition Program?

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