MAHB BOH Recognition Day Nomination Form

To be awarded at State House ceremonies in the Great Hall. March 11, 1999 from 1-3 p.m.

MAHB is seeking nominations for boards of health or individual board members who have made outstanding contributions to their community.
Submission Deadline: Nominations must be post-marked or faxed by Feb. 1st, 1999.

Name of Nominee_______________________
Address________________________________
Nomination type:[ ] individual [ ] board
Please describe how the nominee contributed to one or more of the following achievements:
• Successful efforts in Community Outreach
• Creative solutions to public or environmental health problems
• Outstanding community service

Name of nominator(s)_____________________
Email_________________________________
tel.______________________
Address_______________________________
Specify if you are a fellow board member, agent, other town employee or private citizen (Note criteria #6)

Signature__________________________
Please attach up to two typed pages describing justification for this award. You may also enclose up to two letters of endorsement.

Award criteria
1. Membership in MAHB as either a board member or commissioner where such individual has the statutory responsibilities of the board of health.
2. Evidence of Leadership
3. Documented accomplishment of significant contributions to or advocacy of public or environmental health
4. Activity accomplished through the board of health or health department
5. Community involvement and Citizen Support
6. Public Service nomination must be made by their board of health.
Award Categories:
• Lifetime Achievement Recognizing an individual board member with at least 25 years of service on the board of health.
• Paul Revere Award Recognizing an individual board member who displays outstanding dedication and leadership in tackling a challenging public/environmental health.
• MAHB Public Service Award Recognizing an agent, director or public health nurse for dedication to promoting community health and/or environmental protection and outstanding service to a local board of health.
• Public Health Leadership Award Recognizing a team effort by a board resulting in a creative solution to a complex public or environmental health problem and or/ community outreach.

This is an opportunity to honor board members
and staff and to increase recognition for their
community service. Awards will be presented at the 1999 Board of Health Recognition Day at the State House, as part of a program including legislators and other distinguished guests.

The MAHB Executive Board reserves the right to make any and all determinations.