OUTSTANDING PUBLIC HEALTH LEADER NOMINATION FORM
To celebrate National Public Health Week (April 1-5, 2019) the Wicomico County Health Department will recognize an individual that has made an outstanding contribution to the public health of the citizens of Wicomico County.

The Outstanding Public Health Leader will be honored at an awards ceremony on Wednesday, April 3, 2019 at 3:00 p.m. at the Great Hall in Holloway Hall, Salisbury University, 1101 Camden Ave., Salisbury, MD. The celebration honors an outstanding individual in the area of public health and provides the public with information about public health and services provided for our community. A plaque will be presented to the selected individual and a perpetual plaque will remain on display at the Seth H. Hurdle Health Center.

SELECTION CRITERIA
Nominees must:
* be an individual (not a group or organization);
* be 18 years old or older;
* work in Wicomico County;
* be living;
* have made a contribution to the citizens of Wicomico County (examples follow);
* demonstrate thoughtful attention, energy, and innovation in his/her position;
* make use of current theories and practices in public health;
* not be an employee of the Wicomico County Health Department.

EXAMPLES OF PUBLIC HEALTH CONTRIBUTIONS: (Examples only; others may apply.)
Assess health status to identify community health problems.
Diagnose and investigate health hazards in the community.
Form community partnerships to identify and solve health problems (for example, APEXpH, or Assessment Protocol for Excellence in Public Health subcommittees that perform community needs assessments).
Develop policies and plans to support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Provide or link people to needed personal health services and assure care is received when otherwise unavailable.
Assure a competent public health and personal health care work force.
Evaluate effectiveness, accessibility and quality of health services.
Conduct research for new insights and innovative solutions to health problems.
Improve existing or develop new systems of health care.

NOMINATION INFORMATION
May complete and submit online or print and fax or mail to the attention of Cara Rozaieski, Director of Prevention and Health Communications. Faxes may be sent to 410-548-5184 and mail to Wicomico County Health Dept., 108 E. Main St., Salisbury, MD 21801. All nominations must be received by Monday, March 25, 2019. NO EXCEPTIONS.
Name of Nominee *
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Nominee's Agency or Organization
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Nominee's Mailing Address *
(A formal invitation to the recognition ceremony will be mailed to the nominee.)
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Nominee's Email Address
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Nominee's Telephone Number *
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Nomination Narrative *
Please limit to no more than 400 words. Provide as much detail as possible; examples of work done will strengthen nomination. If submitting paper form, print and type or write clearly on form, attaching no more than 1 page for the narrative.
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YOUR CONTACT INFORMATION
"I have read the selection criteria and wish to nominate the individual identified above."
Your Name *
Your answer
Your Email Address *
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Your Telephone Number *
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