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 dgrabel@med.umich.edu.
Your Name:
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?
Submit
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