Ludwig Community Benefit Nomination Form Associate Members Awards Advancing Safe Care Award Healthcare Leadership Award 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 of Nominated MHA-Member Organization Name of Program Name of Key Contact Person For Program Title Organization Address 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 PhoneFaxEmail(Required) Submitter 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)FaxEmail(Required) NarrativesProgram Overview(Required)Statement Of Problem And Goal (5 points)(Required)State the specific health needs or problem that was addressed and the short- and long-term goals of the program designed to resolve it. Briefly outline the steps taken to reach those goals. Leadership/Community Involvement Role (30 points)(Required)Provide highlights of any collaborative efforts with other healthcare providers, community agencies or other organizations to evaluate the problem and address it properly.Describe how investing in the program improved the health and well-being of individuals both in and out of the hospital.Program Design and Assessment (35 points)(Required)Explain the steps taken to solve the problem by describing the program’s demonstrated and measurable impact on the community’s health and well-being.Provide highlights of how the program advances health equity and/or access to care.Summarize plans for the program’s future, including those for measuring its continuing impact on the community and other stakeholders.Sustainability (30 points)(Required)Describe the financial and time resources necessary to sustain commitment to the program and how the program will evolve in the future.Outline how the cash award will be used to enhance the program, should the organization win the award. NOMINATIONS MUST BE RECEIVED BY THE MHA BY THE CLOSE OF BUSINESS FRIDAY, FEB. 17, 2023. Any additional materials, including photos of the program should be emailed to eleyko@mha.org.Note: Forms will not be accepted if they include URLs.EmailThis field is for validation purposes and should be left unchanged.
