Sunflower Award Nomination Form

Please complete the following information about the person you would like to nominate.

Nominee's Name:

Nominee's Unit/Department:

Nominee's City/Campus:

Additional info:

Please consider including any additional information that may help us identify the nominee (for example: date of visit, patient’s name, etc.)

I would like to nominate this Children’s Minnesota staff member as a deserving recipient of The Sunflower Award. They consistently meet all of the following criteria:

Goes above and beyond to care for the needs of the patient and family
Has a positive attitude
Exemplifies the mission and values of Children’s Minnesota
Is thoughtful, compassionate and caring in all situations
Makes a meaningful difference in the experience of patients, family members or colleagues

Please share a story involving the staff member you are nominating that clearly demonstrates how they meet the criteria for The Sunflower Award:

Thank you for taking the time to nominate an extraordinary staff member for this award. Please tell us about yourself, so that we may include you in the celebration of this award should the staff member you nominated be chosen.

Your Name:

Phone:

Email:

My role (please check one):

Family/Visitor

Patient

Children's Minnesota staff

Other

Is it okay to share this nomination (this may include our Children’s Minnesota internal webpage, social media posts, and/or displayed on unit)?

Yes

Yes, but do not include my name