Nomination Form

The Spotlight Award

To nominate a Mid Coast–Parkview Health team member for The Spotlight Award, please complete the form below. You may also download a printable copy of the nomination form by clicking here.

All team members at Mid Coast–Parkview Health except nurses are eligible, including those working at Mid Coast Hospital, Mid Coast Senior Health, CHANS Home Health & Hospice, Mid Coast Medical Group, as well as the Mid Coast Hospital Walk-In Clinic and Mid Coast Hospital Parkview Campus.

All fields marked with a red asterisk (*) are required.

Team Member's Name: *

Team Member's Department: *

Please describe a specific situation or story that demonstrates how this team member made a meaningful difference in your care: *

Your Name: *

Phone Number:

Email Address:

I am (please check one): *

Patient
Visitor
RN
MD
Staff
Volunteer