Healthcare Leadership Nomination Form Associate Members Awards Advancing Safe Care Award Advancing Safe Care Award Nomination Form Healthcare Leadership Award Healthcare Leadership Nomination Form Ludwig Community Benefit Award Ludwig Community Benefit Nomination Form Meritorious Service Award Speak up Award Special Recognition Award Board of Trustees Careers at the MHA Current Opportunities Committees Councils Member Benefits Associate Membership Bylaws Membership Application Physician Membership Physician Membership Application MHA 100 Year Anniversary Celebration 100 Year Anniversary Timeline Our Hospitals Michigan Hospitals By Health System Staff Directory Nominee InformationName(Required) First Last Job Title(Required) Organization(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Submitter InformationName(Required) First Last Job Title(Required) Organization(Required) Name of Supporting CEO(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Narratives Answer in 1,500 words or lessOrganizational Contributions(Required)Leadership and Culture Contributions(Required)Appointments/Affiliations (List current and previous appointments/affiliations, such as medical staff, governing boards, education, United Way, etc. (with dates, positions held, etc.)(Required)NOMINATIONS MUST BE RECEIVED TO THE MHA BY THE CLOSE OF BUSINESS FRIDAY, MARCH 24.Note: Forms will not be accepted if they include URLs.