2024 Healthy Communities Fellowship Nomination
Nominator's Information
Nominator's Name
First Name
Last Name
Nominator's Organization Name
Nominator's Email Address
Can we contact you if we have any further questions?
Please select...
Yes
No
Candidate's Information
First Name
Last Name
In what field(s) is the candidate an expert? (select all that apply)
Entrepreneurship
Healthcare
Food Security & Nutrition
Housing Security
Criminal Justice
Maternal Health
Public Health
Education
Policy
Other
If "Other" is selected, please enter what field the candidate would be an expert in:
Candidate's Professional Title
Candidate's Organization Name
Candidate's Website
Candidate's Email Address
Candidate's Phone Number
Why are you nominating this leader to be a part of the Healthy Communities Fellowship?
Describe the leader's work and its impact on reducing inequities in their community.
Contact Information