First Name

Last Name

Email Address

Name of Civic Leader

Brief summary of Core business and areas of community impact.

How has nominee demonstrated outstanding leadership in national, regional, or local community outreach for diverse and/or disadvantaged populations? Provide social & economic impact his/her actions has had.

Championing Sustained Awareness for Health & Wellness: How has this nominee demonstrated a sustained commitment to championing awareness and inspiring others to address health and wellness in diverse and disadvantaged communities?

How has this individual positively impacted the quality of care, standards of service, behaviors, and/or policies within healthcare supply chain and patient satisfaction?

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