GPHA Emerging Leader of the Year Award Nomination Form

Please note: These forms do not save and may reset. We recommend you answer the questions in a Word Doc, or other method that saves, and then copy/paste your answers into our form.

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Nominator Information

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Nominee Information

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Describe the nominee's outstanding leadership in the following areas.

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Desribe how the nominee demonstrates the Department’s values and their commitment to improving health and health care.
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CV/Resume of Nominee - REQUIRED
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Supporting Materials - OPTIONAL
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