Fillable Form 1: Indian Health Service Directors Awards INSTRUCTIONS (Indian Health Service / Office of IT)

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Form 1: Indian Health Service Directors Awards INSTRUCTIONS (Indian Health Service / Office of IT)

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1
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service Director’s Awards
INSTRUCTIONS FOR NOMINATIONS
Nominations Deadline: March 13, 2020
The Director of the Indian Health Service (IHS) recognizes individuals or groups of employees whose special
efforts and contributions, beyond the regular duty requirements, have resulted in significant benefits to the IHS
strategic goals, objectives and programs, customers and fulfillment of the IHS mission.
Nominations are to be submitted for one of the following award categories that are based on the nature of the act,
service, or performance.
Award Categories
● IHS Director’s Award
● Fostering Relationships
● Luana Reyes Leadership Award
Please note that the 2019 Director’s Awards covers an individual or group’s performance within the calendar year of 2019.
AWARD CATEGORIES
Director’s Award: This award recognizes service that has significantly advanced the IHS mission and vision
through work focused on the goals and objectives in the IHS Strategic Plan; Access, Quality, and Management
Operations with particular emphasis on quality improvement activities.
Fostering Relationships: This award recognizes service that has significantly advanced the IHS mission and vision, and
the strategic goals and objectives through fostering relationships. This award is designed to recognize innovation and
exceptional performance and/or exemplary actions resulting in quality service to patients and their families, colleagues/
other units or departments, and/or partners of the IHS.
**Luana Reyes: This annual honor is reserved for an individual whose professional and/or community involvement
demonstrates the kind of leadership that Ms. Luana Reyes exemplified. Nominees for this award must demonstrate
exceptional initiative and have made the most of the advantage and opportunities available to them.
**Members of senior leadership are not eligible for this award.
For more information regarding award criteria: https://www.ihs.gov/nda/awardcategoriescriteria/
For more information regarding the IHS Strategic Plan: https://www.ihs.gov/strategicplan/
NOMINATION SUBMISSIONS
The IHS Director's Awards nominations must be initiated and signed by the nominator and the award nominee's supervisor,
then concurred and ranked by the Area Director (Areas & Service Units only) or the respective Headquarters Senior
Leadership (HQ only).
The Area Award Coordinators will coordinate the receipt and review of all nominations and rankings through their respective
Area Director, and all HQ staff will submit nominations through their respective Senior Leadership.
Area Award Coordinators must scan and email all nominations and rankings electronically to IHSAwardNominations@ihs.gov.
Nominations must be received by Friday, March 13, 2020. Nominations received after this date will not be considered. If you
have any questions, please e-mail the IHS Director's Awards Committee at IHSDirectorsAwardsCommittee@ihs.gov.
NOMINATION FORM ATTACHED
2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Nomination Form
Indian Health Service Director’s Awards
Nominations Deadline: March 13, 2020
Complete a separate nomination form for each individual/team nominee.
Submit completed nomination forms with all signatures no later than March 13, 2020 to IHSAwardNominations@ihs.gov
1. AWARD CATEGORIES
Indicate Award Category (select only one): [ ] Director’s Award [ ] Fostering Relationships [ Luana Reyes ]
2. NOMINEE INFORMATION (INDIVIDUAL OR TEAM)
Indicate Type of Award (select only one): [ ndividual [ Team ] ] I
INDIVIDUAL AWARD: *Please list the Individual’s Name as it should appear on the plaque or certificate*
First Name/Last Name: Title:
TEAM AWARD: *Please list the Team Name as it should appear on the plaque or certificate*
Team Name:
Team Lead First Name/Last Name:
*Please use Attachment A (page 4) to list all nominated team members
3. AWARD CITATION: *This text will be used directly in the official award script.* (Please limit write-up
to approximately 25 words or less)
4. Nominator Title: Signature: Date:
5. Award Nominee’s Supervisor Title: Signature: Date:
6. (for Areas only) Area D
irector Signat
ure: Date:
7. (for Headquarters only) Senior Leadership Signature: Date:
8. Area Awards C
oordinat
or Signature: Date:
Name:
Name:
Name:
Name:
Name:
3
AWARD JUSTIFICATION
In the space provided, please explain how the individual or team significantly advanced the IHS mission and vision
through enhancements supporting one or more of the following IHS Strategic Goals: Access, Quality, and
Management and Operations.
Start write-up here..
4
Team Members – Attachment A
Name of Team:
*Please list
each member’s name as it should appear on the certificate*
Team Lead
(Please indicate
one team lead
in the column)
Last Name
First Name
Commissioned Corps Rank OR Title
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Form 1: Indian Health Service Directors Awards INSTRUCTIONS (Indian Health Service Office of IT)

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Completed 7 August 2020

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