Iris Stagner Award Nomination Form

THE 2019 IRIS STAGNER AWARD

The Awards Program: • Highlights a county’s commitment to worksite wellness and its efforts to create IRIS STAGNER a good-health culture for its employees; In honor and • Encourages recognition of and serves to inspire all county coordinators and recognition of sponsors; and Iris Stagner’s • Helps counties recognize the value of their wellness programs and the contribution to the Healthy County volunteers who help make them successful. Wellness Program, the Iris Stagner Eligibility and Evaluation Criteria Award will be To be eligible for the award, a nominee must be a current Healthy County wellness bestowed annually to an individual within the Texas Association of coordinator or sponsor. Each nominated person is evaluated individually based on Counties (TAC) Health and Employee their ability to meet the following criteria: Benefits Pool who exemplifies health • Meet the vision of TAC’s Healthy County program, which is to optimize the promotion excellence for their county. health and well-being of its members;

What is the Iris Stagner Award? • Motivate employees to participate in Healthy County wellness programs; The Iris Stagner Award recognizes • Organize and plan health-related activities using various resources; and outstanding leadership and innovation • Gain leadership support for wellness programs throughout their county. as a Healthy County wellness While nominations submitted by counties are considered for the Iris Stagner Award, coordinator or sponsor. This award the Healthy County team will also consider Wellness Coordinators or Sponsors who was created in honor of Iris Stagner, former Palo Pinto County wellness may have not been nominated. coordinator, to recognize a coordinator or sponsor who embodies the qualities Award Nominations and enthusiasm Iris possessed To nominate someone for the Iris Stagner Award, please complete a nomination form throughout her tenure. and include a detailed narrative describing the nominee’s efforts as a Healthy County Iris was Palo Pinto County’s wellness coordinator or sponsor. Individuals can nominate others or themselves. enthusiastic wellness coordinator of Nomination forms must be signed by either the county judge or a commissioner. four years, a member of the BikeTexas board of directors and a longtime promoter of bike safety and education. Award Ceremony She was killed on Sept. 17, 2012, when The winner will be recognized at the Healthy County Conference, Feb. 20-22, 2019. hit by a pickup truck during a training ride on U.S. Route 180 outside of Mineral Wells, Texas.

The mission of the Iris Stagner Award is to honor the most enthusiastic and innovative among the best Healthy County wellness coordinators and sponsors. IRIS STAGNER Nomination Form

Instructions 1. Complete this entry form and attach it to the narrative. The narrative should describe the nominee’s qualifications as they pertain to the evaluation criteria in the award description. Forms can be submitted electronically. 2. Use the attached pages to write the narrative. 3. The deadline for nominations is 5 p.m., Jan. 28, 2019.

1. Contact Information (person to whom correspondence should be sent)

Name______

Wellness Coordinator or Sponsor (circle one) Department______Address______City/State/ZIP______Telephone ______Fax ______Email______

2. Signature of the County Judge or Commissioner

Name______Title ______Signature______

3. Authorization

Please check this box to approve the online posting of your winning nomination form and video to the TAC website.

Send completed nomination to: Healthy County, Texas Association of Counties P.O. Box 2131, Austin, TX 78768 [email protected] Nomination must be received by 5 p.m., Jan. 28, 2019. 4. Person Nominated and Title

Person Nominated:______County: ______

Please describe the nominee’s qualities and accomplishments as their county’s leader for the Healthy County program (attach additional pages as needed).

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