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Collaborative Nomination Form * Indicates a required field

One collaborative (comprised of three or more health-related Georgia nonprofit organizations) will be selected for this award. In order to be considered for the award, the following requirements must be met.
A list of previous recipients can be found here.

For assistance with this form, please email

Collaborative nominees must:

  • Be actively working together
  • Represent partnership models working towards promising practices and results
  • Show initiative and a deep commitment to addressing health-related needs of the community
  • Demonstrate that the collaborative effort has been effective in improving the health of a Georgia community
  • Reflect diversity in its membership
Nominee Information

Alternate address

Nominator Information

Alternate address

Collaborative Award Criteria

Please email any attachments that you would like to include with your submission to

Once you press submit, this form cannot be revised. Upon submission, you will receive an email confirmation of your nomination.