Nominate your peer or team for recognition by the Ohio Chapter of SCCM

On behalf of the Ohio Chapter of SCCM, we would like to recognize the extraordinary efforts by our members and their colleagues. 

To recognize the extraordinary efforts by our members and their colleagues,  we would like to send a small token of appreciation to those working on the frontlines.  If you would like to nominate your team or unit, please fill out this brief survey.  Nominations will be reviewed regularly and placed into a lottery.  Winners will be announced on social media!

If your unit/team is selected you will be asked to take a photo of your team to post on social media and make flyers about the Ohio Chapter of SCCM available to the cookies/treats.

Question Title

* 1. Name of nominator (First and Last)

Question Title

* 2. Credentials of nominator

Question Title

* 3. Email address of nominator

Question Title

* 4. Phone number of nominator

Question Title

* 5. Institution

Question Title

* 6. Unit/Team Name

Question Title

* 7. Institution address (for delivery)

Question Title

* 8. Brief description of why you are nominating this unit/team

Question Title

* 9. Does your hospital allow outside deliveries (i.e. Cheryl's cookies, Au Bon Pain, etc)?

Question Title

* 10. Are you wiling to commit to assisting with organizing the delivery (I.e. pick up from lobby of hospital and/or coordinating delivery with the Ohio Chapter of SCCM leadership)?

0 of 10 answered
 

T