(18 years or younger)
(18 years or older)
If partnership, list all partners
Summarize in no more than 500 words why the nominee deserves to be recognized for their achievements that have contributed to the public health mission “to protect and promote the health and safety of the community”. Describe as fully as possible how the nominee meets one or all the selection criteria of leadership, community health improvement, collaboration, and/or advocacy. If the nomination is for work-related responsibilities, address any activities or collaborations within Anoka County that resulted. Please refer to the selection criteria and nomination instructions when you complete your nomination.
Up to 1,000 words
For multiple files please upload them in a Zip file.
Deadline for nominations forms is January 31, 2018.
This field is not part of the form submission.
* indicates a required field