2024 Outstanding Rural Health Organization Nomination Form

Nominee Information

The Outstanding Rural Health Organization Award recognizes any community-based group or organization that has improved access to health services and information for rural people through innovative, comprehensive approaches. Factors considered include outreach, preventive health and education, quality and efficiency of care, and strong community support and involvement.

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* 1. Nominee Information

Organization Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 2. Organization Administrator/Primary Contact

Name

Title

Email Address

Phone Number

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* 3. Rural Geographic Area(s) affected by nominee’s work

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* 4. Organization Information/Resources

Optional: Upload any materials you would like to include that describe the organization..

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* 5. Organization Website (if applicable)

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* 6. Nominee’s contribution to rural healthcare.

Please attach a word or PDF document with a 300-500 narrative describing the nominee’s involvement in rural health, the significance of the organization's contribution to rural health, and how the rural area and residents have benefited from the organization..

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File