COGA Member Spotlight Submission Form

You may share information about yourself or another COGA member. Please provide your contact information as the submitter so we may contact you if we require additional information.

Question Title

* 1. Please provide your contact information. We may need to contact you for additional information regarding your submission.

Name

Phone

Email Address

Question Title

* 2. If you are sharing information to spotlight a
COGA colleague, please share their name and email address.

Name

Email Address

Question Title

* 3. Please select the practice area most closely associated with spotlighted activity being shared.

Food and Nutrition Security

Prevention and Wellness

Health Care and Health Systems

Other

Other (please specify)

Question Title

* 4. Please share activities or accomplishments that you would like to have spotlighted.