2024 Professional Service Award Nomination Form

NOMINATION PROCEDURES: Complete this form and submit it by clicking on the “submit” link at the bottom. Before you send the email, attach any supporting documents you wish to be considered by the judges. You are allowed up to 10 pages of supporting documents, and these should be submitted in the form of PDFs.

PURPOSE: This award recognizes an administrator, owner, or corporate-level employee of a THCA member facility for distinguished professional service. Judging will focus on how the individual contributes significantly to the positive image of the profession in the community. Judges will also consider how the individual displays leadership and a high standard of ethical behavior, contributes to the well-being of residents and the overall success of the facility, takes initiative, and has a positive attitude that boosts staff morale.

This form may be completed by either the nominee or the individual submitting the nomination.

Person Completing This Form:*

Email of Person Completing This Form:*

Name of Nominee:*

Title:*

Facility/organization:*

Address:*

Street Address Address Line 2 City State ZIP Code

Nominated By:*

Title:*

Facility:*

Address:*

Street Address Address Line 2 City State ZIP Code

I have confirmed that the nominee plans to attend the Annual Convention & Trade Show with his/her facility.*

Yes
No

List two media outlets that should receive a press release about this nomination.*

Major accomplishments:*

Leadership roles:*

List several examples of how the nominee shows initiative.*

Give specific examples of how the nominee shows a positive attitude and boosts staff morale.*

Describe how this nominee’s leadership has fostered outstanding service to residents and improved the facility as a whole. Give examples.*

Describe how the the nominee contributes to the positive image of the long-term care profession in the community.*

Professional organizations participation:*

Additional Supporting Files:

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 5 MB, Max. files: 10.

Accepted Formats: PDF, DOC, DOCX | Max # Files: 10 | Max File Size: 5MB

Phone

This field is for validation purposes and should be left unchanged.

THCA/TNCAL Convention & Trade Show