Healthy Lafayette Online Nomination Form

The Health Care Foundation of Greater Kansas City (HCF) is accepting nominations for the Healthy Lafayette Award. This award will be presented to an individual or organization that promotes good health among the uninsured and underserved in Lafayette County.

Whether it's a teacher who encourages healthy lifestyles for his or her students or a volunteer who drives those needing health care to an appointment or perhaps an organization that advocates for access to health care for the uninsured, the award recipient should play a role in making his or her community healthier for low-income individuals and families.

A person is able to nominate him/herself or an organization or individual who has taken steps to improve the health of those in Lafayette County. Nominations will be accepted through May 15, 2012 and will be reviewed by a panel of judges representing the HCF Board of Directors, Community Advisory Committee and Associates. To ensure the recipient is chosen objectively, the judges have developed a point system to measure the nominee's level of involvement in health improvement activities and the impact of the activities. The recipient will be announced in June. Current and former HCF Board or CAC members are not eligible.

The recipient will receive a plaque and the recipient's organization will be awarded a $5,000 grant if he or she works for a health-related organization that is eligible for HCF funding. If the recipient is an individual or business, the $5,000 grant will be awarded to a health-related, eligible nonprofit organization in Lafayette County of the recipients choice.

Nomination Criteria

Nominations will be judged on:

  • Nominee organized or was the leader of initiative(s) that helped underserved individuals and families in Lafayette County lead a healthier life.
  • Nominee has actively influenced public policies that helped uninsured or underserved people in Lafayette County lead healthier lives.
  • Nominee has been a significant participant in events and activities that helped uninsured and underserved individuals and families in Lafayette County lead healthier lives.
  • Nominee has worked or volunteered to help the uninsured and underserved individuals and families in Lafayette County lead healthier lives.

Nomination Form

I/We Nominate the following person or organization:

If the nominee is a person, please enter his/her company or organization above.

In 500 words or fewer, please describe below how this person/organization has helped promote good health in Greater Kansas City among the uninsured and underinsured. Please include any initiatives, activities or events that the nominee has taken an active role in.

Nominated by (please enter your information below):

Type the characters you see in this picture. (verify using audio)
Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.