Ludwig Community Benefit 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 Committees Councils Member Benefits Associate Membership Bylaws Conference Room Reservation Form Data Reporting Services Membership Application Physician Membership Physician Membership Application Our Hospitals Michigan Hospitals By Health System Public Health Partnerships Vaccinations Staff Directory PhoneThis field is for validation purposes and should be left unchanged.Nominee InformationName of Nominated MHA-Member OrganizationName of ProgramName of Key Contact Person For ProgramTitleOrganizationAddress 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. Describe the program’s demonstrated and measurable impact on the community’s health and well-being. 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 origin of the organization’s commitment, what has sustained that commitment, and how it will be maintained in the future. Outline how the 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 WEDNESDAY FEB. 18, 2026. 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. Δ
