Submit your 2018 entry online by Monday December 4, 2017

All entries must be submitted on-line. Supporting documentation should be scanned and submitted in pdf format. Original documents cannot be accepted. Potential award recipients must be nominated by someone other than themselves. No submissions will be returned and the decision of our judges is final. To complete the submission process you will need the contact information of the person submitting the nomination (Name, hospital or practice affiliation and email address) as well as the same contact information of the person being nominated (we must have contact info in order to notify finalists). In addition, you will be asked to write a description of why you believe the person being nominated best exemplifies the spirit and action of a true Patient Advocate. Your description is limited to 1,000 words. Each submission must be accompanied by supporting documentation. The minimum required documentation for each entry are 1) a letter pf recommendation from the nominee’s immediate supervisor or department head, and 2) a letter of recommendation from either a co-worker, colleague or a patient or family member of a patient that was assisted by the nominee. Additional (optional) documentation may be submitted, which could include newspaper clippings, additional letters of support, citations or other awards received, etc. Remember that all documentation must be scanned and submitted in pdf format.

Nominator

(Hospital, Organization, etc.)

Nominee

(Hospital, Organization, etc.)

Why should this nominee be selected? (1000 word essay maximum)

Please add supporting PDF documents