2026 Healthy Communities Fellowship Nomination
Nominator's Information
Nominator's Name
First Name
Last Name
Nominator's Organization Name
Nominator's Email Address
Nominator's Phone Number
Can we contact you if we have any further questions?
Please select...
Yes
No
Candidate's Information
In what field(s) is the candidate an expert? (select all that apply)
Entrepreneurship
Healthcare
Food Security & Nutrition
Housing Security
Criminal Justice
Maternal Health
Public Health
Other
If "Other" is selected, please enter what field the candidate would be an expert in:
First Name
Last Name
Where is the candidate currently located (City and State)?
Candidate's Professional Title
Candidate's Organization Name
Candidate's Website
Candidate's Email Address
Candidate's Phone Number
Why are you nominating them to be a part of the Healthy Communities Fellowship?
Describe their work and its impact on the community in addressing inequities.
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