2023 Assisted Living Caregiver Nomination

Name: Colorado Health Care Association
Address: 4100 E. Mississippi Ave. Suite 925, Glendale, CO, 80246
Telephone: 303-861-8228

Name of Nominee*
Job Titles*
Number of Years in Current Position*
Number of Years With the Facility*
Number of Years in the Long Term Care Industry*
Community/Facility Name*
Who Is Nominating This Person?*

*Contact Person-Person Submitting the Form*
Nominator's Email Address*
Nominators Phone Number*
Secondary Contact Person Email*
Facility Address*
Facility Phone Number*
Describe what the nominee does above and beyond to promote and enhance the quality of life for the residents or the overall operations of your community*
Share a Story that illustrates the nominees excellent qualities*
References (Name, Email and Phone Number of two individuals to submit a nomination letter)*
This may be a resident/family or someone that works with the nominee. Please provide those submitting a nomination letter this link: https://www.cohca.org/2023-spotlight-on-excellence-nomination-story/ . Each Nominee may only receive one or two nomination letters.

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