WHI Community Ambassador Nomination Form
Dear WHI Member,
Thank you for your interest in nominating a person from your community to participate in the WHI Steering Committee by serving as a Community Ambassador.
Please complete and submit the form below. Any questions about the form or position can be answered by Deana Smith at
Please provide your contact information (email or phone):
What is your role in the WHI (i.e. a community member, a representative from a health system, community organization, etc)? If you represent an organization, please specify.
Name of person you are nominating:
Please provide contact information for the person you are nominating (email or phone):
How do you know the person you are nominating?
Briefly share (2-3 sentences) why you think this person would be a good fit for the WHI. What insight or lived experience would they bring to the table?
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