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Nominee

Nominator:

Optional

Please use this section if you feel additional support is necessary.

Letters of Recommendation:

Please submit a letter of recommendation with this application. Email it to Ann Myers at Ann@ForBetterHealthPA.org.

Photo:

Optional - Send a photo of the individual and/or their organization’s work in the community to Ann Myers.

References:

Please share contact information for one reference who can speak to the nominee’s accomplishments.

Reference:

Applications are due by April 3, 2017

Address questions to: Ann Myers, Chief Gift Planning Officer, at Ann@forbetterHealthPA.org