Beacon "Inspire" Associate of the Month Nomination Form

Question Title

* 1. What entity does your nominee for Associate of the Month currently work for?

Beacon Corporate Services

Beacon Medical Group

Elkhart General Hospital

Memorial Hospital (includes Beacon Granger Hospital and Epworth Hospital)

Bremen Community Hospital

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* 2. Please enter the name of the Associate you are nominating.

First Name

Last Name

Location/Dept/Floor

Question Title

* 3. Please provide your name as the nominator.

First Name

Last Name

Enter your Location/Dept/Floor

Employee Number

Question Title

* 4. Beacon Values

Compassion, Integrity, Respect, Trust

Please select at least one value you feel your nominee consistently demonstrates. Please provide examples and details from
your experience working with the Associate and or observing
the Associate. Please share specific reasons why you feel this Associate has demonstrated the chosen value(s).

Example:

"I'll never forget when he/she..."
"It really impressed me when ..."
"I felt that he/she truly cared when I saw him/her..."