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Paradigm Award Self Assessment Registration
(National labor efficiency & quality award)
Your Contact Information - [* denotes a required field]

*Name:(i.e., First & Last)
*Title:(e.g., HR Leader)
*Email:
*Number:(i.e., Area code, Number, and Extension)
Good time to be reached:(e.g., 2-4pm)
*Time Zone:(e.g., EST)
Organization Information - [* denotes a required field]

*Organization Name:
*Address:
*City:
*State:
*Zip:
Participant Information - [* denotes a required field]

At least 4 of the following 5 positions MUST participate in a brief self evaluation survey in order to qualify for the award. Those positions are: CEO/President, COO/VP Ops., Sr. Finance Leader, Sr. H.R. Leader, and Sr. Nursing Leader. Although only four are required, all five are encouraged to participate.

CEO/President
*Will Participate?[If Yes, the following fields are required]
*Name:
*Email Address:
*Phone Number:

COO/VP Ops.
*Will Participate?[If Yes, the following fields are required]
*Name:
*Email Address:
*Phone Number:

Sr. Finance Leader
*Will Participate?[If Yes, the following fields are required]
*Name:
*Email Address:
*Phone Number:

Sr. Human Resource Leader
*Will Participate?[If Yes, the following fields are required]
*Name:
*Email Address:
*Phone Number:

Sr. Nursing Leader
*Will Participate?[If Yes, the following fields are required]
*Name:
*Email Address:
*Phone Number:

Contact information is considered confidential and not shared with any third parties. Once this data has been checked, the email addresses of the participants will be used to send instructions on how to take the online survey. Phone numbers will only be used as a last resort option to contact the participant should any complications arise. If there are questions about the information provided the award committee will attempt to contact you to clarify.

The participants and/or you may contact the award committee at any time during this process regarding questions or issues at 1-888-343-8403

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