If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required Nomination Categories (Please check one): * Volunteer of the YearProfessional of the YearPhilanthropist of the YearBusiness of the YearNonprofit of the YearYouth or Youth Group Nominee Name of Nominee: * Title: * Address: * Phone: * Email: * Nominator: Nominator's Name: * Title: * Address: * Phone: * Email: * Summary of Major Contributions: How have this organization's or individual's accomplishments been outstanding in advancing the health of our community? * As a result, how has our community and the population benefited in the areas of: 1) improved access to affordable health care and/or; 2) promotion of healthy lifestyles? * 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: Name: * Relationship to the Nominee: * Phone: * Email Address: * Applications are due by April 3, 2017 Address questions to: Ann Myers, Chief Gift Planning Officer, at Ann@forbetterHealthPA.org
