2024 SCHCHA In-Home Aide of the Year - Nominee Profile Form

Criteria for the Award:
This award is designed to recognize in-home aides in the home health, home care, or hospice industry. The nominee must have a minimum of one year experience working in home health and/or hospice.

Do not use the name of the nominee or any identifying information (such as agency name) on your narrative or in your answers. Please do not skip any questions or your nomination will be disqualified.

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* 1. Name of Nominator

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* 2. Agency of Nominator

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* 3. Nominator's Phone

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* 4. Nominator's Email

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* 5. Agency, Nominee's Name, Title, and Credentials

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* 6. Nominee's Agency and Address

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* 7. Nominee's Email Address

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* 8. Nominee's Phone Number

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* 9. Number of years worked in home care and/or hospice

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* 10. Describe the care provided by this individual and how he/she serves as an advocate for patients (100 words or less)

Remember: Do not use the Nominee’s name or agency in your response.

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* 11. Describe this individual's work habits and how he/she demonstrates excellence. (~100 words)

Remember: Do not use the Nominee’s name or agency in your response.

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* 12. Describe how this individual supports other members of the interdisciplinary team (100 words of less)

Remember: Do not use the Nominee’s name or agency in your response.

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* 13. Describe efforts undertaken by this individual to enhance their professional growth (100 words of less)

Remember: Do not use the Nominee’s name or agency in your response.

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* 14. Explain why this individual deserves this distinguished award over all other nominations (100 words or less).

Remember: Do not use the Nominee’s name or agency in your response.
 
 100% of survey complete.

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