DR. WILLARD C. SCRIVNER PUBLIC HEALTH FOUNDATION

Carolyn Chapman Distinguished Service Award

For an outstanding contribution to public health in St. Clair County

The Board of Directors of the Willard C. Scrivner Public Health Foundation is pleased to invite nominations for the Carolyn Chapman Distinguished Service Award (DSA).

Named in the honor of Carolyn Chapman, founding member of the Scrivner Foundation Board of Directors, the DSA recognizes an individual who has made an outstanding contribution to public health improvement in any community in St. Clair County.

Nominees need not live in St. Clair County, but nominations should be based upon their contributions to the county or region.

Applications are due by April 14, 2023. The award will be presented at 6:30 p.m. on May 9, 2023 at the Health Department (dependent on Covid-19 restrictions). If you have any questions, please contact Kristy at (618) 233-7769 ext. 4463.

Name of Nominee(Required)

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Nominee's Address(Required)

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Describe the outstanding contribution to the public health movement this individual has made which makes the nominee eligible for this award.(Required)

Describe the impact of this contribution.(Required)

Why should this individual be considered for this award at this time?(Required)

Attach copies of any supporting documentation for this nomination.

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Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 5 MB, Max. files: 10.

Your Name(Required)

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Street Address City State ZIP Code

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DR. WILLARD C. SCRIVNER PUBLIC HEALTH FOUNDATION

Carolyn Chapman Distinguished Service Award

For an outstanding contribution to public health in St. Clair County

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