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2. The Maricopa County Department of Public Health is pleased to issue a Call for Nominations for the 2022 Climate and Health Champion Awards. This countywide recognition program will identify and celebrate local youth, individuals, businesses, organizations and researchers that are taking steps to reduce risks of climate-sensitive hazards and work toward implementing sustainable solutions or eco-friendly practices/policies aimed at improving health and health equity.

3. Award Category (Select One):*

   1. Youth (18 years and under)
   2. Individual
   3. Business (private sector)
   4. Organization
   5. Research
5. Individual or Group to be Nominated:
   NOTE: You can self-nominate.

7. CONTACT INFORMATION FOR PERSON/ENTITY BEING NOMINATED
9. First Name:*
10. Last Name:*
12. Address:
13. Phone Number:
15. City:
16. Email Address:
18. State:
19. Zip Code:
21. Climate-sensitive hazard target area(s) [Check all that apply]:*

    1. Air Quality
    2. Heat
    3. Flooding
    4. Drought

    1. Wildfires
    2. Dust Storms
    3. Vector-Borne Disease
    4. Other (please describe below)
22. If "other," please describe:

24. FOR BUSINESS/ORGANIZATION NOMINEES ONLY
26. Nominee's Role in Business/Organization:
27. Length of Service in Business/Organization:

29. FOR YOUTH NOMINEES ONLY
31. School Attending:
32. Grade Level:

34. TO BE COMPLETED BY PERSON SUBMITTING FORM
36. Nominator's First Name:*
37. Nominator's Last Name:*
39. Address:*
40. Email Address:*
42. City*
43. Phone (with Area Code):*
45. State:*
46. Zip Code:*
47. Organizational Affiliation (if applicable):

49. NOMINATION LETTER (REQUIRED)

51. A nomination letter (2 page maximum) that provides a rationale outlining why the nominee should be recognized as a Climate and Health Champion is required for submittal with this application (can be self-nominated). ALL nomination letters should include the following:

    • Description of specific work that improved health and/or health equity in Maricopa County and how novel the work is;
    • The climate-sensitive hazard(s) targeted (air quality, heat, flooding, drought, wildfires, dust storms, vector-borne disease, or other); the length of time the work has been ongoing; and how reproducible the work is within other areas of the county;
    • How the nominee has worked with others (if applicable); and
    • Results or outcomes from these efforts; the size and type of population being served; and the significance of the contributions in improving the health of the community.

    
    

    In addition:

    • Youth/Individual Nominees should include background and highlights of career or academic achievements; volunteer/extracurricular activities; and relevant prior honors/awards.
    • Business/Organizational nominees should include a brief description of the company/organization, including employee or membership profile and mission/purpose.
53. Upload Letter (2 page maximum):*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

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