2024 Outstanding Rural Health Program Nomination Form

Nominee Information

The Outstanding Rural Health Program Award recognizes a community, regional, or statewide program involving one or more health professionals or entities that promotes or facilitates the development of rural health delivery systems. Factors considered include coordination of services with other health care agencies to avoid duplication of services, networking and collaboration with other health care entities to achieve common goals, innovation in development and implementation, and lasting impact on populations and areas served.

Question Title

* 1. Nominee Information

Program Name

Organization(s) Involved in Program

Program Primary Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 2. Program Lead/Primary Contact

Name

Organization Name

Title

Email Address

Phone Number

Question Title

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

Question Title

* 4. Program Information/Resources

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

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

Choose File

Question Title

* 5. Program Website (if applicable)

Question Title

* 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 program's contribution to rural health, and how the rural area and residents have benefited from the program.

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

Choose File