2023 Northeast Florida World AIDS Day Committee Awards Nomination Form

 

Instructions to complete:

1. Only one nomination per ballot.

2. Please check only one category per ballot when making nomination.

3. Only one nomination per category.

4. Use the space provided below and back of page. State WHY you are nominating this person or agency, or your nomination WILL NOT be considered.

5. You must print and sign your name below as well as include contact information for your nomination to considered.

6. Use your best writing so the committee can read your nomination.

7. “Canned” nominations will be discarded.

8. Alterations/changes to the ballot are prohibited and those ballots will be discarded.

One category per ballot, Categories are:

• Person Living with HIV of Year (Person living with HIV who has demonstrated leadership)
• Provider Service Person of Year (Person who works in the field serving those living with HIV. Example:Case Manager, HOPWA, Peer Navigators, Receptionist , Attorneys, etc.)
• Provider Service Agency of Year (Agency who provides services to those living with HIV. This can be any agency that works with HIV positive persons, does not have to be Ryan White provider.)
• Nurse of the Year (Nurse or nursing assistant who provides services to those living with HIV)
• Medical Provider of the Year (Provider who prescribes and provides medical services for persons with HIV)
• Nominees are selected based on QUALITY not quantity