Create Entry Form - Corporate Social Responsibility

ENTRY FORM FOR
CORPORATE SOCIAL RESPONSIBILITY CATEGORY

The award is for an undertaking that made a difference in the improvement of healthcare in the community. Is the project or program sustainable? Does the hospital merely provides resources or makes it an integral part of its community involvement. Does the hospital give of its management time and expertise? Is it innovative? More weight is given to how meaningful is it to the community it serves.

INSTRUCTIONS

  1. Please fill out all the sections below and abide strictly by the word count. Words exceeding the maximum word count will be cut off automatically/truncated.
  2. ONLY entries and attachments submitted online will be accepted.
  3. IMPORTANT: It is necessary that the CEO certifies that all information you provide is true and correct by signing the form indicated in the last page.
  4. By submitting an entry, you agree that HMA will share relevant aspects of the Entry submitted on the HMA or related Resource Center website.
Background Information
Date Project Started
Format: 06/19/2013
Format: MM/DD/YYYY
PLEASE ANSWER THE FOLLOWING QUESTIONS USING THE MAXIMUM WORD ALLOCATIONS INDICATED
Name and contact details of person submitting entry (* Required fields)
Supporting Materials

All entries need to be accompanied by documentation to support your entry such as:

  1. Press reports
  2. Awards won
  3. Commendations received
  4. Comments and testimonials from stakeholders
  5. Measurable results achieved
  6. Anything to convince the judges that your entry meets the criteria best.

Supporting materials MUST be in English or, if they are in another language, a certified translation must be provided. You may send up to 5 attachments of any other supporting material.

Attached files must be no larger than 1.5MB each. Documents must be in .pdf or .doc (word) format, images must be in .gif or .jpg format, short edited videos must be in .wmv or .avi format. No exceptions sorry.

Note: If you wish to send any files larger than 1.5MB please email them directly to alexrodriguez@exedraevents.com. Maximum of 2 such files per entry can be submitted and should not be more than 10MB in total size.

CEO Certification

Please click here to download the certification to be signed by the CEO. Then please scan the signed form and attach it as a supporting material.

Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg wmv avi.
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg wmv avi.
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg wmv avi.
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg wmv avi.
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg wmv avi.
Additional File
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg.
Note: If you wish to send any files larger than 1.5MB please email them directly to shynebacani@exedraevents.com. Maximum of 2 such files per entry can be submitted and should not be more than 10MB in total size.
Files must be less than 1.5 MB.
Allowed file types: pdf doc gif jpg.

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