Please fill out the form below to nominate your colleagues for OPCA's Annual Awards of Excellence

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* 1. Email

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* 2. Please list your name, job title, and organization

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* 3. Please select the award you're applying for

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* 4. Please name the nominee(s) for this award, along with their title(s) and organization(s)

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* 5. Please tell us about the community your organization serves and some of the challenges patients and/or employees face each day. (250 words or less)

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* 6. How did the nominee(s) learn about the problem they set out to solve? What inspired them to act? (250 words or less)

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* 7. When they started their work, what challenges did they face in making their vision a reality? (250 words or less)

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* 8. Did the nominee(s) partner with others or other organizations? If so, what kinds of support did they give or receive? (250 words or less)

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* 9. What is the lasting impact of the nominee(s) work? (250 words or less)

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