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Spirit of Women
Community Health Needs Assessment

2015 St. Luke's Hospital Healthy Woman Award

Deadline for Nominations: September 1, 2015

Complete the following nomination form, including answers to the three narrative questions below.

Winners will be notified in early October. Each winner will receive a complimentary ticket for herself and a guest to St. Luke's Hospital Spirit Girls' Night Out on October 8, 2015, where she will be recognized.

Nomination process and award details
Eligible nominee must:
  • Be available to be interviewed by the Selection Committee, if selected as a finalist.
  • Consent to the publication of her name, photo and story if selected a winner.
  • Be available to accept her award at the St. Luke's Hospital Spirit Girls' Night Out event on Thursday, Oct. 8, 2015, if selected a winner.
  • Not currently be an employee, physician or volunteer of St. Luke's Hospital.
Each nomination form is reviewed by the Spirit of Women Committee and finalists are invited for a personal interview. Nominees will not be discriminated against due to race, color or religious preference.

* Required
Nominee's First Name: *
Nominee's Middle Initial:
Nominee's Last Name: *
Nominee's Street Address: *
City: *
State or Province: *
Zip or Postal Code: *
Nominee's Daytime Phone: *
Nominee's E-mail Address: *
Verify Nominee's E-mail Address: *
Individual or Organization Submitting this Information
First Name: *
Middle Initial:
Last Name: *
Street Address: *
City: *
State or Province: *
Zip or Postal Code: *
Daytime Phone: *
E-mail Address: *
Verify E-mail Address: *
How did you hear about this award? *
Why should this nominee be recognized with a Healthy Woman Award? Specifically:
How has she impacted her own health through healthy behaviors or accomplishments? (200 words max) *
(You have 1300 characters left.)
How has she helped others pursue better health or made our community a healthier or safer place? (200 words max) *
(You have 1300 characters left.)
What specific traits or talents does she possess that inspire you and others? (100 words max) *
(You have 650 characters left.)

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St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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