2027 Healthy Communities Fellowship Nomination

Nominator's Information

Nominator's Name

First Name

Last Name

Nominator's Email Address

Nominator's Organization Name

Can we contact you if we have any further questions?

Candidate's Information

First Name

Last Name

Candidate's Email Address

Where is the candidate currently located (City and State)?

Candidate's Organization Name

Candidate's Professional Title

Candidate's Website

If "Other" is selected, please enter what field the candidate would be an expert in:

Why are you nominating this leader to be a part of the Healthy Communities Fellowship?

Describe the leader's work and its impact on reducing inequities in their community.

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Contact Information