Ludwig Community Benefit Nomination Form

Nominee Information

Address

Submitter Information

Name(Required)
Address(Required)

Narratives

  • 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.
  • 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.
  • 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.
  • 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.
    This field is for validation purposes and should be left unchanged.