VCHA is hosting our Annual Membership Meeting and Conference September 16 - 18, at DoubleTree by Hilton Hotel Williamsburg. During the event, we will be recognizing our membership for their achievements during our annual awards ceremony. If you wish to nominate and individual or group for an award, please complete this form by Friday July 31.

*1.Your Contact Information (Nominator):(Required.)

First and Last Name

Health Center

Job Title

Email Address

Phone Number

*2.Nominee:(Required.)

First and Last Name

Health Center

Job Title

Email Address

*3.Which award are you nominating this individual?(Required.)

Provider of the Year

Nurse of the Year

Volunteer of the Year

HR Professional of the Year

Staff Member of the Year

Special Recognition Award

Behavioral Health Professional of the Year

Dentist of the Year

*4.Why are you nominating this individual? Describe why you believe the nominee meets the qualifications of the award, including specific achievements, impact on your community, anecdotes, or data.(Required.)

5.Please describe the nominee's role and how their achievements have contributed to enhancing access to primary care for the undeserved, as well as to your overall health center's mission.

6.Please share any other thoughts or comments about why you believe this nominee should be granted this award.

7.(Optional) Provide any additional information about the nominee: Interests, hobbies, family life, where they grew up, etc.