2026 KAYCHW Awards Nomination Form
Help us recognize Kentucky's outstanding Community Health Workers and CHW Champions who are making a lasting impact across the Commonwealth. Award Categories include: Extra Ordinary Contribution Award, CHW Champion Award, and Outstanding CHW Award. Please review each award description before submitting a nomination. Include specific examples and, if possible a photo of the nominee in action. Nominations close Friday August 7, 2026.
EXTRA ORDINARY CONTRIBUTION AWARD
Recognizes a current or former Community Health Worker who has gone above and beyond advancing the CHW profession and improving the health and well-being of individuals or communities through exceptional leadership, service, advocacy, or innovation.
Nominee's Full Name
*
First Name
Last Name
Nominee's Email Address
*
example@example.com
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Nomination
*
CHW CHAMPION AWARD
The CHW Champion Award recognizes an individual, or community leader who has demonstrated exceptional support for Community Health Workers and the CHW profession in Kentucky. Through advocacy, collaboration, leadership, or partnership, this champion has strengthened the work of CHWs and helped improve health outcomes across the Commonwealth.
Nominee's Full Name
*
First Name
Last Name
Nominee's Email Address
*
example@example.com
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Nomination
*
OUTSTANDING CHW AWARD
The Outstanding Community Health Worker Award recognizes a current or former Community Health Worker who has demonstrated exceptional dedication, compassion, leadership, and services to the individuals and communities they serve. This award honors a CHW whose work has made a measurable difference through advocacy, education, care coordination and efforts to improve health equity across Kentucky.
Nominee's Full Name
*
First Name
Last Name
Nominee's Email Address
*
example@example.com
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Nomination
*
Your Contact Information
Ways to contact me if information is needed on my nomination
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Submit Nomination
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