Recognizing Individuals, Organizations, or Coalitions the Represent the African American, American Indian, Asian American and Hispanic/Latino American Communities

During the 2017 Minority Health Month, the community will recognize a Community Action Leader Awardee, working to improve minority health.

The recipient from each community will have demonstrated leadership in improving the health of their respective population and meet the criteria for nomination below. The person selected will be recognized locally and will be honored in a special ceremony during Minority Health Month on Tuesday, March 28, 2017, in Columbus, Ohio, at the Vern Riffe Government Center.

Criteria for Nominations include Impact on the Community, Innovation, and Perseverance.  See the Nomination Packet for criteria details.

Deadline to Submit Nominations: 4:30 p.m., Friday, December 2, 2016. See Deadlines for Getting a Nomination Packet and Submission Guidelines below on page 2.

Nomination Process:

  • Complete the Nomination Packet, which includes a Nomination Form and Candidate Criteria Forms. Additional pages can be added as needed. Please write legibly. Public Health/Dayton Council on Health Equity is not responsible for information that is illegible.

PHDMC’s Community Action Leadership Award Nomination Committee will review all Montgomery County nominations received by the deadline, and select the Awardee in each racial/ethnic category. If there are no nominations, PHDMC will submit Final Nominees to the Commission. The Ohio Commission on Minority Health will review all nominations from across the state of Ohio and select one Awardee for each racial/ethnic category.

The awardees will be notified by the Ohio Commission on Minority Health in early March, including details on how to attend the award ceremony. If you have any questions, please do not hesitate to contact Cheryl Scroggins at 937-225-4962.

You can enter/nominate one candidate for each ethnic group:

  • African American
  • American Indian
  • Asian American
  • Hispanic / Latino

The person nominated must be a living person who resides in Ohio and who assists or serves Montgomery County residents.

Deadlines for Getting a Nomination Packet:
Deadline for submitting nominations is 4:30 pm, Friday, December 2, 2016

Obtaining the nomination form:

  • Internet: The form is downloadable pdf here. (283 KB)
  • or Email: You may also request the form by sending an email to  with the Subject line “Requesting nomination form”

Submitting the nomination form:

  • Email to
  • or Fax to (937) 496-3071

Failure to submit a legible/readable Nomination Form and/or Award Criteria form may disqualify the person for consideration due to inability to read the information.

If you have questions, please contact Cheryl Scroggins before 4:30 p.m., on December 2, 2016, at (937) 225-4962 or . No nominations will be accepted after the deadline.

Nomination packet:  pdf OCMH Community Leadership Award 2017 Nomination Packet (283 KB)




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