Rhapsody Award nomination form

Nomination form

As a trusted partner, we value you reaching out to us. We will do our best to respond within 2-3 business days.

Suite 701, 10130 - 112 Street NW
South Tower
Edmonton, Alberta
T5K 2K4 Canada

1 (780) 423-9911

info@rhpap.ca

Nominator Contact Information

First Name

Last Name

Nominator Email

Nominator Phone Number

Award Nomination Information

Nominee Name / Team Name

Nominee Email

Name of Rural Community

How long has the nominee lived in the rural community?

Does the nominee live in the same rural community where they work?

Yes

If no, where do they live?

How long has the nominee(s) worked in healthcare in the rural community?

Award Category

Rhapsody Physician Award

Rhapsody Healthcare Heroes Award

Submissions

Nomination Letter

Upload File

Max file size 10MB.

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Photo of Nominee

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Max file size 10MB.

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Consent

I acknowledge that, if successful, the nominator will provide support and the nominee will participate in the filming of a feature video, as well as an appreciation event where the award will be presented.

Thank you! Your submission has been received!

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