2017 HMHB Carolyn Wetzel Award Nomination Form
The Carolyn Wetzel Continuum Award recognizes volunteers and health professionals who contribute to the health and well being of Georgia's families. This award is in memory of Carolyn Wetzel, a long-time member, friend, and dedicated public health advocate for mothers and babies. This award will be presented at our Annual Meeting on October 23, 2017 at Oconee Fall Line Technical College in Dublin, GA. Criteria for selection include:
• Role model for peers
• Demonstrated commitment to achieving equity in healthcare for Georgia’s women and children
• Positive change agent in the public arena of advocacy and policy
Questions? Call 770-451-0020.
DEADLINE TO SUBMIT: August 30, 2017
Nominee (Individual or Organization)
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Nominated By (Your Name)
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Nominee's Address
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Nominee's Work Phone
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Nominee's Personal Phone
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Nominator's Phone (Your Phone Number)
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Nominee's Occupational and/or Volunteer Accomplishments:
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How does this candidate serve as a role model for peers?
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How does this candidate demonstrate commitment to achieving equity in healthcare for Georgia’s women and children?
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Carolyn Wetzel was deeply involved in affecting policy change throughout her career. How does this candidate serve as a positive change agent in the public arena of advocacy and policy?
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Can you help us assure that this nominee, if selected, will attend the Annual Meeting 10/23-10/24/2017 at Oconee Fall Line Technical College in Dublin, GA?
Your Electronic Signature
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