First Name

Last Name

Email Address

Name of Diverse Business: 3rd Party Certified: Minority-, Woman-, Veteran (disabled)-, or Disabled-owned Enterprise

SELECT THE NOMINEE’S CORE BUSINESS AND AREAS OF SERVICE Medical/ Surgical ManufacturerSupplierLogisticsIT/ Technology or SoftwareService ProviderOther

If you selected "Other" please identify the type of business. (i.e. medical-surgical manufacturer, supplier, logistics, consulting, other)

In what ways has the nominee demonstrated vision and entrepreneurship positively impacting the healthcare industry and/or inspired their organization to excel as well?

How has nominee demonstrated a high standard of service through behaviors or policies benefiting the healthcare supply chain? (Consider: quality, innovation or service offerings, customer service, etc.)

In what ways has the nominee improved the quality of care delivered to patients or contributed to overall patient satisfaction? (Consider: nominee inspired offerings to the patient populations)

Provide examples of how your business has made a difference in the communities in which you serve.

Comments