UICOMP Community Health Award Nomination Form

✔ Yes! I have a great nominee for the UICOMP Community Health Award!

NOTE: Previous winners are not eligible for award.

Nominator Information

(who is making the nomination)





answer must be an email address


Nominee Information

required6. Nominee Type

If you are nominating an organization or program, please list the leader or contact for that organization or program.





answer must be an email address

required12. Qualifying Criteria

Please check one or more of the following ways in which the nominee promotes community health:

Please enter your answer below, or type uploaded if you prefer to upload your answer as a Word document (bottom).