VOYCE - Caregiver Awards Luncheon Nomination Form
NOMINATION APPLICATION INSTRUCTIONS
1. You must submit one application for each nominee. Please let us know if your nominee(s) require any special accommodations at the event.

2. Submit your Early-Bird nomination by Friday, August 23 and the nominator and nominee both receive 5 free raffle tickets towards a $150 gift basket of your choice at the Caregiver Awards Luncheon. Nominations accepted through September 13, 2019. A confirmation email will be sent once nomination form is received and when photos and logos are received. If you do not receive confirmations, email nominations@voycestl.org or call 314-918-8222.

3. After you complete this Nomination Form, please send the following to nominations@voycestl.org:
-- Print and complete the Nominee Photo Release/Signature form. LINK---> https://bit.ly/2NMs24p
-- Email the nominee color headshot (jpg, 300 dpi)
-- Email your organization logo (eps or jpg, color, 300 dpi)

4. Each organization can nominate two full-time or part-time staff members and one volunteer (in some nomination categories). Maximum number of nominations per community is three. The nominating organization is responsible for purchasing an event ticket for their nominees.

5. Eligible nominees can be from skilled nursing, assisted living and residential care communities, medical and non-medical in-home providers, hospice agencies and adult day care programs in our 21-county service area.

6. Nominees must be direct line caregivers and must have direct interaction with those receiving care (excludes administrators). Consider nominating individuals from nursing, social services, therapy, activities, administrative, clergy, housekeeping, laundry, food service and maintenance. Non-staff nominees can assist in any volunteer aspect. Ombudsman volunteers are not eligible.

7. Nominations can only be submitted by an employee within the same organization as the nominee.

8. We will use all submitted application information in marketing materials associated with the Caregiver Awards Luncheon before, during and after the event.

9. During the selection process, the judges will not know the name or organization of the nominee. Award recipients will be announced the day of the luncheon. An organization can have a maximum of two award recipients.
Email address *
Award Category
**Eligible nominees must have worked for 20+ years in any of the categories as defined in #5 above, must be available to attend the Caregiver Awards Luncheon on December 5, 2019 and be willing to participate in media opportunities two weeks before the event. Nominees in this category will not be considered for other awards.
Organization Type *
Nominee First Name *
Your answer
Nominee Last Name *
Your answer
Nominee Organization *
Your answer
Nominee Position/Title *
Your answer
Years in Position? *
Your answer
Total Years at Organization? *
Your answer
Nominee Address, City, Zip, and County *
Your answer
Nominee Phone *
Your answer
Organization Address *
Your answer
Contact Person First Name *
Your answer
Contact Person Last Name *
Your answer
Contact Person Title *
Your answer
Contact Person Email *
Your answer
Contact Person Phone *
Your answer
Marketing Representative
Your answer
Marketing Representative Title
Your answer
Marketing Representative Phone Number
Your answer
Describe how the organization reflects a culture of care for residents, clients, staff and families (50 words or less) *
Your answer
Describe how the nominee delivers exceptional care by recognizing individual rights and by providing kindness and compassion to those in his or her care (400 words or less) *
Your answer
Provide a specific story that best demonstrates how the nominee has provided exemplary care. The example should offer how the nominee goes above and beyond expectations to meet the needs of those entrusted to his/her care, to recognize/represent the individual's rights as well as provide kindness and compassion to the individual in his or her care (200 words or less) *
Your answer
I understand that I need to provide the following additional items to nominations@voycestl.org for the nomination to be considered. The info below will also be sent in a confirmation email once you submit this form. --------------------------------------- Please send the following to nominations@voycestl.org: ------- Print and complete the Nominee Photo Release/Signature form. LINK---> https://bit.ly/2NMs24p ------- Email the nominee color headshot (jpg, 300 dpi) -------- Email your organization logo (eps or jpg, color, 300 dpi) *
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