Howard University Hospital

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NOMINATION FORM: All nominees should be highly regarded in their respective fields. Each must have demonstrated commitment in the healthcare industry. These individuals must be recognized experts in health and scientific research and have displayed a long-term commitment to the advocacy of critical minority and general health issues. They should exemplify the ideals of "excellence in service and leadership."

To nominate an individual/organization for a Legacy of Leadership Award, please complete the following form in its entirety. Submissions without biographical data will not be considered.

Please check one nomination category:

Distinguished Healthcare Leader

Distinguished Healthcare Advocate

Distinguished Healthcare Educator

Individual/Organization Submitting Nomination:

Address:

 
Phone:

I/We Nominate:

Full Name:

Title:

Home Address:

Home Phone: Fax:

Business Name:

Business Address:

Business Phone: Fax:

 

Please provide a biographical summary which includes academic and professional achievements, honors and awards, community service and any other supporting information or materials.

 


Howard University Legacy of Leadership Awards Committee, University Events and Special Projects
2225 Georgia Avenue NW, Suite 829, Washington, DC 20059. Phone: 202-238-2548. Fax: 202-588-9864. Email: hhalisi@howard.edu
Copyright 2001 Legacy of Leadership Awards Committee. All rights reserved.
Revised: April 2003.