Childbirth & Maternal-Child Health Champion Nomination Form

2017 Childbirth & Maternal-Child Health Champion

Awards Nomination Form

 

Submit this form by July 8, 2017. Winners announced August, 2017.

Honorees recognized September 27, 2017
at a Ceremony at California Endowment Center, Los Angeles, CA

NOMINATION CATEGORIES:

Visionary Of The Year

Description: For exemplar and paradigm-shifting models of childbirth and/or maternal and infant health, causing significant social change or improvement in childbirth nationally, locally or internationally.

Agent-Provocateur of the Year

Description: To honor a person who has demonstrated revolutionary ingenuity in developing programs and projects promoting the health of mothers and infants and/or transforming childbirth locally, nationally or internationally.

Lifetime Acheivement Award

Description: To honor a person who has shown many years of dedication, perseverance and service to mothers and infants & the birth professional community. This category can be given to someone posthumously or living.

Dr. Paul M. Fleiss MD Future Leader Award

Description: To honor an up and coming professional/student in the field who shows great promise and aptitude to make a significant change in society or the field of medicine, midwifery, nursing or doula support. This award is given in honor of beloved Los Angeles pediatrician Paul M. Fleiss, MD, MPH, who inspired and supported many maternal-child health practitioners and leaders.

Most Audacious Award

Description: To honor a MCH or Childbirth professional who has shown remarkable courage and boldness to change childbirth or maternity care.

Reason why they should be nominated (Describe their contributions to the profession, accomplishments, achievements and/or potential. What makes this person extraordinary? What category are you nominating them in, and why?

 

Childbirth and MCH Champion Nomination Form

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