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Health and Wellness Award nomination form

Awarded by the City’s Advisory Board of Health, this award recognizes an outstanding individual(s), business or organization that has made a significant impact on the health and wellness of Bloomington residents.

Eligibility

The Nominee must be an individual(s) who lives or works in Bloomington or a business or organization based in Bloomington that has made a significant impact on the health and wellness of Bloomington residents.

Nomination requirements

Please include all of the following with your submission:
  • Full names, addresses etc. of the nominee (individual or institution) and the nominator
  • A narrative detailing the nominee’s service, accomplishments, or other contributions for which this award is proposed

Deadline

Nominations for the 2019 Health and Wellness Award must be received by Friday, February 8, 2019. Nominations received after this deadline will not be considered.


Nominee


Nominator


Narrative

Tennessen warning
Please take notice that any data received by the City as the result of submitting this form will be classified as government data pursuant to the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13. Under the Data Practices Act, some or all of this data is classified as public data, including your name, address, email address, phone number, and other personal information provided by you. Public data is available to anyone requesting it and consists of all data furnished via this Web form. Please be advised that the correspondence will be added to the public record. The purpose and intended use of the information collected through this form is to obtain public input and data in support of City activities and services. You have the right to refuse to submit this form. If you choose not to submit this form, you will need to contact the City by another means if you wish to provide the information collected by the form.

Nondiscrimination and accommodation commitments
The City of Bloomington does not discriminate on the basis of disability in the admission or access to, or treatment or employment in, its services, programs, or activities. Upon request, accommodation will be provided to allow individuals with disabilities to participate in all City of Bloomington services, programs, and activities. Upon request, this information can be provided in Braille, large print, audio tape and/or electronic format. 

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