GHG Scholarship Program

Doctors' Day Nomination Form

Deadline: December 14, 2012

Minimum Criteria

  • Must have served as an active, courtesy, associate professional, or adjunct member of the Genesis Health System for a minimum of 1 year
  • Must be in good standing within Genesis Health System
  • Must be in compliance with Genesis Health System rules and regulations
  • Must exemplify the Standards of Behavior and excellent practice standards of Genesis Health System

Alternate Submissions

Click here if you would like to fill out the paper nomination form instead of using the Web form below.

 

Your Name:* 
Your Phone Number:*
Physician Name*

Please Choose One - click on each award type to see nomination criteria.* 
 Community Service/Humanitarian Award
 Colleague Award for Quality Care (Nominated by Physicians Only)
 Patient Service Excellence Award
Please provide a written description that outlines the accomplishments/qualifications of the nominee.
Awards will be criteria based and final selection determined by the Doctors' Day Award Committee.

Selections will be announced and recognized in an event on March 12th and honored on Doctor's Day, March 30, 2013.