NOMINATOR (YOUR) INFORMATION








Leadership Champion award
Community Champion award

NOMINEE INFORMATION


Yes
No

Nominee must be an ACHI Member for at least three years to be considered.

Academic medical center
Academia
Ambulatory care center
Association
Children’s hospital
Consulting firm
Health system
Hospital
Other healthcare provider
Physician group
Rural hospital
Vendor
Other




0-5 years
5-10 years
10-20 years
20+ years

Served on the ACHI Advisory Council
Served on a ACHI committee or task force (describe below)
Served as a speaker or moderator for an ACHI conference or webinar
Been an exhibitor at a ACHI Annual Conference
Membership in ACHI - enter the number of years in the box
Other ACHI committee or task force (please specify)



Nomination Narrative: Describe how the Nominee has developed and/or implemented policies or strategies that have facilitated continual improvement for the health of the community they serve, particularly in regard to at-risk populations. (Maximum 1000 words)
  • What was the impetus for developing this strategy?
  • What communities/populations that were impacted by this policy/strategy?
  • How data was collected and utilized to identify measurable outcomes?
  • How have the efforts of the individual contributed to the success of the policy or strategy?
  • How are community partners engaged?
  • Describe the Nominee’s personal and leadership attributes that qualify them for this award. (please refer to ACHI’s values – collaboration, equity, excellence, innovation and integrity)

Click "Choose File" to upload your narrative below.

Nomination Narrative: Describe how the Nominee led the program implementation and have facilitated improvement for the health of the community they serve, particularly in regard to at-risk populations (Maximum 1000 Words)
  • Describe project goals, evolution, barriers and successes
  • Describe the unique elements of this program that set it apart or contribute most to its success
  • Please include scorecards, dashboards and results that the Nominee utilized in the program’s implementation
  • Describe what elements of the project could be replicable by other individuals and or organizations
  • Describe the Nominee’s personal and leadership attributes that qualify them for this award. (please refer to ACHI’s values – collaboration, equity, excellence, innovation and integrity)

Click "Choose File" to upload your narrative(MS Word or PDF format) below.