nomination form


This is it—your chance to show us why your nominee should be the next Peoples Health Champion!

Make sure that you have all the information about your nominee prepared in advance so you can easily enter it into the form below. If you want to use any of our tips and suggestions on the “Inside Tips for Nominations” page to help determine what to write, reference them before you start completing the form.

Once you start completing the form below, you won’t be able to view the “Inside Tips for Nominations” page without losing any information you already typed into the form.

Once you complete the form, click the “Submit” button, and you’re done. We look forward to reading your nomination!

Please complete the form below. Mandatory fields are marked  as required.