Algoma Public Health - Public Health Champion Nomination Form

NOMINEE INFORMATION

Who are you nominating?

Select One * (Select One)

Individual
Youth
Organization

Name * (if individual)

Organization (if applicable)

City

Reason for Nomination * Please describe your reason for nominating this person/organization (500 words or less). What makes them a Public Health Champion. Deadline for submissions: January 10, 2024 @ 12 PM EST

TELL US ABOUT YOURSELF

Information to be kept confidential

Name *

City *

Email * (if applicable)

Phone Number (if applicable)