Nominate a Community Champion

For more information about Community Champions click here.

Molina Healthcare of Florida's annual Community Champions Awards event will be held in Miami on April 16, 2020. We are currently accepting nominations now through March 15, 2020.

Nomination Form​

Please fill all the required fields (*) Please select captcha

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Nominee Information:

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(*) Please Enter the value for Name.
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(*) Please Enter the value for Title
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(*) Please Enter the value for Organization.
Please enter a 10 digit telephone number
Please enter a valid email address
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(*) Please Enter the value for Home Phone Please enter a 10 digit telephone number
Please enter a 10 digit Mobile number
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(*) Please Enter the value for Personal Email Please enter a valid email address

Nominee Profile:

Please describe the nominee’s community contributions, achievements and qualities that qualify him/her for consideration. :

Please include specific examples in the following areas:

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(*) Please Enter the value for Key Contribution
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(*) Please Enter the value for Nominee Activities
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(*) Please Enter the value for Unique Qualities
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(*) Please Enter the value for Additional Activities
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(*) Please Enter the value for Defining Word

Nominating Individual or Organization Information:

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(*) Please Enter the value for Name
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(*) Please Enter the value for Sponser Phone Please enter a 10 digit telephone number
Please enter a 10 digit Mobile number
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(*) Please Enter the value for Email Please enter a valid email address

Organization Profile: