2024 My SoCal Hospital Heroes Nomination Form

To nominate someone as a 2024 Hospital Hero, please fill out the form below (one form for each nomination). Nominations are due Friday, July 26.

If you prefer to use the PDF nomination form, please email it with any supporting documents to [email protected] by Friday, July 26.

We look forward to hearing from you!

2024 My SoCal Hospital Heroes Nominations

"*" indicates required fields

Nominator's first and last name*

Hospital name*

If part of a health system, facility location

Address*

City*

State*

Zip*

Phone*

Email*

Nominee's first and last name*

Nominee's department*

Nominee's title*

Nominee's phone*

Nominee's email

What makes your nominee a Hospital Hero?*

File upload

Text field

You can upload a PDF or Word file or type in/paste your answer. Please describe how your nominee has stood out in contributing to your team over the past 12 months. Include details and examples of the nominee’s outstanding work, character, care for patients and colleagues, etc.

Why your nominee is a hero

Please describe how your nominee has stood out in contributing to your team over the past 12 months. Include details and examples of the nominee’s outstanding work, character, care for patients and colleagues, etc.

Why your nominee is a hero (PDF or Word upload)

Accepted file types: docx, doc, pdf, Max. file size: 50 MB.

Please upload a Word or PDF document describing how your nominee has stood out in contributing to your team over the past 12 months. Include details and examples of the nominee’s outstanding work, character, care for patients and colleagues, etc.

(Optional) Additional file upload

Drop files here or

Accepted file types: jpg, gif, png, pdf, mp3, mp4, Max. file size: 50 MB, Max. files: 5.

Include up to five media files, such as photos, video or audio, to support your nomination.

Comments

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2024 My SoCal Hospital Heroes Nomination Form

2024 My SoCal Hospital Heroes Nominations

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