Champions of Hope Nomination
We are now accepting nominations! Please submit the name of a candidate for donation champion recognition.
This nomination is for:
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Please Select
Individual
Organization
Name of individual being nominated:
Title of individual being nominated:
Email of individual being nominated:
*
Name of individual's leader:
Organization or hospital with which the individual is affiliated:
Areas of experience the individual fills in relation to this nomination (check all that apply)
Bureau of Motor Vehicles staff
Community Outreach staff
Coroner’s Office staff
Funeral Home staff
Education staff/Teacher
Donation Liaison
Labor and Delivery staff
Nurse
Physician
PR/Marketing staff
Respiratory Therapy staff
Social Worker
Spiritual Care staff
Hospital Executive/Management
Transplant Center staff
OB/GYN provider
OB/GYN staff
Other
If “other” was selected above, please fill in area of experience here
I believe this individual displays the following Champions of Hope tenet(s) (check all that apply):
Advocacy
Collaboration
Compassion
Diversity, Equity and Inclusion
Innovation
Please provide details on a specific case, situation or additional information that shows why this individual is a donation champion.
I believe this individual displays the following quality/qualities of a champion of donation (check all that apply):
Finds ways to incorporate the message of donation into their daily work
Helps increase awareness of organ, eye and tissue donation
Helps increase awareness of placenta donation
Implements processes/systems to ensure that every opportunity for donation is realized
Collaborates with others to make donation happen
Cares for donors and their families
Cares for recipients and their families
Promotes donation awareness with internal and external stakeholders
Works to bring donation awareness to multicultural communities
Works to decrease donation disparities within multicultural communities
Honors donors, their families, recipients and/or those waiting for their lifesaving gifts
Name of organization being nominated:
Name of leader who should be made aware of nomination:
First Name
Last Name
Title of leader
Email of leader
example@example.com
Area for which this organization should be recognized in relation to this nomination (check one):
Community Outreach & Education
Placenta Donation Champion
Donor Hospital Champion
I believe this organization displays the following Champions of Hope tenet(s) (check all that apply):
Advocacy
Collaboration
Compassion
Diversity, Equity and Inclusion
Innovation
Please provide details on a specific case, situation or additional information that shows why this organization is a donation champion.
I believe this organization displays the following quality/qualities of a champion of donation (check all that apply):
Cares for donors and their families
Cares for recipients and their families
Collaborates with other organizations to make donation happen
Helps increase awareness of organ, eye and tissue donation
Helps increase awareness of placenta donation
Implements processes/systems to ensure that every opportunity for donation is realized
Promotes donation awareness with internal and external stakeholders
Works to bring donation awareness to multicultural communities
Works to create a culture of donation throughout the organization
Works to decrease donation disparities within multicultural communities
Nominator Information
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First Name
Last Name
Affiliated Organization
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Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Submit
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