Health Care Heroes Nomination Form
Nominations for Health Care Heroes are now open and will close on September 13, 2019 at 5:00 p.m.

As you complete this form, please note that the amount of text you may enter in the nomination detail box is unlimited. All fields are required.

Keep in mind that the information you provide is the only information that the judges will be given to base their decisions upon.

Please be thorough and provide specific examples of why this individual/organization in the Charleston region should be honored as a 2019 Health Care Hero.

Please note: Don't forget our newest category - Service/Therapy Animal.

This category honors an animal and its owner or trainer who make an impact in health care. This category includes therapy and other service-related animals.

And, for the 7th year, we have the Trident Construction Health Care Engineer category.

The description of this category is: Health Care Engineers are individuals who are directly employed by a health care facility (i.e., an organization that provides direct patient care such as an acute care hospital, ambulatory care center, etc.) and are responsible for the physical environment of the health care facility.

Thank you for your nomination.

Email address *
Nominee Information:
First Name *
Your answer
Last Name *
Your answer
Award Category *
Click the drop down box to choose the award category
Company *
Your answer
Title *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Email *
Your answer
This hero deserves to be honored because: *
Be sure to TELL YOUR HERO'S STORY IN DETAIL! This is the ONLY information that the judges will use to score the nomination.
Your answer
Nominator Information
First Name *
Your answer
Last Name *
Your answer
Company *
Your answer
Title *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Email *
Your answer
A copy of your responses will be emailed to the address you provided.
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