Foundation Health Community Award HEALTHY COMMUNITY AWARDS Each year, the Hancock Health Foundation recognizes a local organization and individual whose service efforts have created positive change in the health and wellness of our local communities. The recipients will be notified and announced publicly before the end of the year. Bert Curry Healthy Community Award- Named in honor of the Hancock Health Foundation’s first Executive Director, this award recognizes an individual who has demonstrated a commitment to helping others and improving health and wellness in our community. Bobby Keen Healthy Community Award- Named in honor of the former HRH President & CEO, this award recognizes a hospital program or local organization that has made a significant and positive impact on the health and wellness of our community. Selection – The Foundation’s Awards & Scholarships Committee will receive nominations and annually select at least one recipient to receive each award. Below you will find a nomination form. Please feel free to contact Allyson Smith with any questions or concerns at 317-468-4106 or email asmith@hancockhealth.org. Nominations are due by November 21st at 4pm. Healthy Community Award Nomination Form The Hancock Health Foundation is currently accepting nominations for the Bobby Keen Healthy Community Award and the Bert Curry Healthy Community Award. The award is presented annually to a local organization and an individual, respectively, for their exemplary and innovative service effort to create positive change in the health and wellness of our community. If you would like to nominate an organization or individual for consideration, please submit the following nomination form. You may submit additional documentation to support your nomination The Awards & Scholarships Committee will make their decision solely on the information provided in this application and will not consider any prior knowledge they have of the nominee. Nominations are due by November 21st Are You Nominating an Individual for the Bert Curry Healthy Community Award? Yes No If Yes, please provide the name of the individual you are nominating: If Yes, please provide the name of the individual you are nominating: First Name First Name Last Name Last Name Are You Nominating an organization or group for the Bobby Keen Healthy Community Award? Yes No If Yes, please provide the name of the organization or group you are nominating: 1. Tell us about the individual or organization you are nominating. How long have they been in our community? What is their mission or the focus of their work? 2. Please provide specific details about the impact this individual or organization has had on the health of our community (eg volunteer hours served, number of people helped) 3. How does this individual or organization go above and beyond to be innovative and create positive change? 4. Please share any other information that will be helpful for us to know. Please provide your contact information in case we need to reach out to you: Your Name: Your Name: First Name First Name Last Name Last Name Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Address Email Phone Submit If you are human, leave this field blank.
