Healthcare Heroes Award Nomination Form

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Rural Communities

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Nomination Details
If nominating an Individual please provide their name*
If nominating a Team, please provide the team name*
Please also provide the names of the individuals that are part of the team.
Rural Community*
Why is this nominee deserving of this award?*
Please speak to the nominee's involvement in innovative projects and/or patient experience improvement or team-building initiatives.
Bonus: Is this rural community currently involved in RhPAP’s Attraction and Retention Network?/Are you currently working on health workforce attraction and retention with your local RhPAP community consultant?*
- Yes
- No
- I don't know
Name of local RhPAP community consultant (if you know it)
First Last
Nominee Contact Information
Name*
Address*
Street Address City Province Postal Code
Phone*
Email*
Nominator Contact Information
Name of primary nominator*
Please provide information for the individual coordinating the nomination.
Address*
Street Address City Province Postal Code
Phone*
Email*
Does this nominator live in the same community as the nominee?*
- Yes
- No
Name of secondary nominator
For a nomination to be eligible, at least one of the nominators must be from the community of the nominee.
Address
Street Address City Province Postal Code
Phone
Email
Letters of Support
At least three letters of support that describe the nominee’s notable commitment to the community and local service groups including involvement in innovative projects and/ or patient experience improvement or team-building initiatives, the obstacles the nominee has overcome to achieve their contributions, and any relevant anecdotes, narratives, or testimonials.
1. a community organization
2. a health professional in or near the community who can speak to the nominee's health-care background, experience, contributions, and scope of practice
3. another group or individual other than the nominator
4. Letters of support should include the following:
1. Community Impact*
A letter from a group or individual other than the nominator who can speak to the nominee’s community involvement and/or volunteer work outside of health care
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 300 MB.
2. Health Practice*
A letter from a health professional or health administrator in or near the community who can speak to the nominee’s health-care background, experience, contributions, and scope of practice. This should include a least some of the following:
- How the nominee goes above and beyond to provide health care in their community

- How the nominee works within a multidisciplinary team environment to provide health-care services in their community
- The involvement of the nominee in training students and colleagues (including other health professionals on the team)

- The attraction and retention of other health professionals to the community

- Any programs, education initiatives, innovations, etc. that the nominee has championed or introduced to the community
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 300 MB.
3. Healthcare Support*
A letter from a community organization as evidence of community support and impact, and how that commitment and involvement has improved the community, resident experience, and access to health care.
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 300 MB.
4. Additional Letters of Support
From a group or individual other than the nominator.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 300 MB.
5. Media Stories or Pictures
We encourage nominators to submit copies of media stories, photos, etc. that help to demonstrate why your nominee deserves to be the recipient of a Rhapsody Award.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 300 MB.
Consent*
I acknowledge that if successful, the nominator will support and the nominee will participate in, an appreciation event of which the award presentation will be a part.
Where did you hear about the Rhapsody Awards? (Select all that apply.)*
- RhPAP website
- RhPAP e-newsletter
- RhPAP conference, webinar, or event
- Other conference, webinar, or event
- Social media
- RhPAP staff
- Word of mouth
- Other
If you selected "Other" above, please explain:

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RhPAP supports health-care services throughout rural Alberta, which are provided on both historical and contemporary Indigenous lands. These lands include the territories that are home to Treaty 6, Treaty 7, and Treaty 8, as well as the Métis Regions and the Inuit people. We recognize and acknowledge the Indigenous people who have for generations been the traditional keepers of these lands. We are grateful to work and live together on this territory and for the opportunity to learn from all the traditional peoples of these lands as we move forward together in reconciliation.

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Healthcare Heroes Award Nomination Form

Rural Communities

Nomination Details

Nominee Contact Information

Nominator Contact Information

Letters of Support