NKF Healthcare Leadership Award Nomination Form
At the annual Dining with the Stars event, the National Kidney Foundation presents three awards, one of which is the Healthcare Leadership Award. This award honors our region’s leading healthcare professionals who strive to improve, not only the everyday lives of their patients and colleagues, but their community as well. We aim to recognize leaders in our healthcare community including caregivers, volunteers, administrators, board leadership, support services, physicians and innovators.

You may nominate anyone that works in health care: doctors, nurses, techs, social workers, or administrators. Nominations are due July 1, 2019. Dining with the Stars will be held Thursday, November 7, 2019 at the Executive Caterers at Landerhaven.

Name of Person Completing this Form *
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Email Address of Person Completing this Form *
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Name of Nominee *
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Nominee's Email Address *
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Nominee's Phone Number *
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Nominee's Job Title *
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Nominee's Employer *
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How many years has the nominee worked as a renal healthcare professional? *
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How has the nominee worked to improve the lives of their patients? *
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How has the nominee worked to improve the lives of their colleagues? *
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How has the nominee worked to improve their community? *
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Is there anything else you would like to share about this nominee?
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