NOMINATE YOUR
HEROES FOR THE
MPN HEROES PROGRAM

Recognize individuals, institutions, and organizations who act above and beyond in their efforts to support patients with MPNs.

Instructions | View program rules

*Indicates a required field.

1.
Select a nomination category below*:
  |  More Information

Recognizes individuals who provide or demonstrate care, guidance, education, or support above and beyond the standard of care for one or more patients with MPNs

  |  More Information

Recognizes leadership in developing services and programs that address the needs of patients with MPNs, families, friends, caregivers, and healthcare professionals by advancing the science and medical understanding of MPNs, education, awareness, or approaches to care

2.
Please choose the option that best describes who you are nominating*:
3.
Who is the nominee?
(The nominee must be aware that they are being nominated.)

Name of nominee*
Affiliated organization / institution
(if applicable)
Phone*
Email*
Address*
City*
State*
ZIP code*
4.
Please select the option that best describes why you are nominating this individual, organization, or institution.*
5.
Please answer the following questions about the nominee. Please keep in mind that the judging panel considers each written response in their review of the nominations, so provide a robust response that illustrates how your nominee has gone above and beyond.
A. Why does your nominee deserve to be recognized? What actions has your nominee taken that led you to nominate this individual, organization, or institution?*

1200 characters remaining

B. To provide the judging panel with an understanding of the outcomes of your nominee's actions please outline details addressing either*:
  • The measurable impact of an individual's or organization's actions on the life of an individual such as rides provided for doctors' visits, navigation to insurance or financial resources to increase access to care, or time volunteered to increase quality of life.
Or
  • The measurable impact of an individual's or organization's actions on the MPN community through details such as numbers of patients served, materials disseminated, survey results, patient improvements.

1200 characters remaining

6.
We may need to contact you regarding your nomination. Please provide the following information:
My name is*:
Best way to reach you*:

All information provided in this submission will be used only for the purposes of conducting the MPN Heroes® Program. The program judges, steering committee, and others involved in conducting the program will have access to the nomination information. This information will not be sold, rented, or otherwise shared with others.

NEED HELP?

Give us a call at 1-844-MPN-HERO (1-844-676-4376)

Download a nomination form and send it in (PDF)

DOWNLOAD
NOMINATION INSTRUCTIONS:
Each nominee will be considered by a judging panel. Please note, this is not a vote and nominees will not be selected based on the number of nominations they receive. Please keep in mind that the judging panel considers each written response in their review of the nominations, so provide a robust response that illustrates how your nominee has gone above and beyond.
  • Choose only 1 category for each nominee
  • Clearly state the MPN (PV, MF, ET) patient need being addressed
  • Be sure that the achievements of the nominee are recent. All achievements should have taken place within approximately the last 24 months
  • An organization may submit an entry for its own program, with the following conditions:
    • The nomination can be for only 1 specific activity or program
    • Only 1 entry per year can be submitted
    • Independent confirmation is strongly encouraged
  • Individuals can be recognized posthumously
  • Individuals, organizations, or institutions can be nominated by themselves or by others, with the following conditions:
    • They must be aware of the nomination
    • The nomination must be approved by, and compliant with, any institutional rules and guidelines
  • Individuals or organizations may not be recognized two years in a row or for a length of time agreed upon by the judging panel. Click to view past Heroes
RECOGNITION PROGRAM 2016 RULES:

The MPN Heroes program recognizes dedication to individuals and the MPN community. Individuals or organizations can be nominated in 1 of 2 categories. Recipients will be selected by a judging panel's review of nominations for recognition. In Category A, up to 4 recognition plaques will be given to chosen recipients, and in Category B, up to 4 monetary donations to non-profit organizations and societies will be given in recognition of the 4 recipients recognized in this category. Incyte will make monetary donations to select non-profit 501(c)(3), US-based organizations or societies that improve the lives of individuals with MPNs.

Criteria for nominations in either category are as follows:

  • Choose only 1 category for the nominee to be considered
  • Clearly state the MPN (MF, PV, or ET) patient need being addressed
  • A completed nomination form must be submitted by September 8, 2016
  • The achievements of the organization or individual must be recent (ie, should have taken place within the last 24 months)
  • Organizations may submit an entry for their own program, but it must be for 1 specific activity or program and only 1 entry per year, and we strongly encourage independent confirmation
  • Individuals can be recognized posthumously
  • Institutions, organizations, or individuals can be nominated by themselves or by others, but they must be aware of the nomination, and the nomination must be approved by, and compliant with, any institutional rules and guidelines

Exclusions:

  • Employees or agents of Incyte, MK&A, or other Incyte vendors and members of their immediate family are not eligible for recognition
  • Nominated individuals, institutions, or organizations and the programs or activities nominated must originate and be executed in one or more of the 50 states of the United States, the District of Columbia, or Puerto Rico
  • Nominated programs must be independent of purchase, use, and prescribing for any Incyte product
  • Programs or activities that Incyte provided grants or other funding for directly
  • Political lobbying activities
  • Medical research or publications that have been funded or directed by Incyte
  • Any nominee whose organization or institution does not allow recognition in the manner set forth in this program
  • Nominated individuals or organizations must serve or be involved with the myelofibrosis (MF), polycythemia vera (PV), or essential thrombocythemia (ET) communities
  • Judging panel reserves the right to exclude nominations of individuals for any perceived conflict of interest
  • Individuals or organizations may not be recognized two years in a row or for a length of time agreed upon by the judging panel. Click here to view past Heroes
COMMITMENT TO THE INDIVIDUAL

Types of work honored include dedication by a nurse, Healthcare Professional, or caregiver whose contributions to a person with an MPN have had a clear impact.

When completing your nomination:

Describe in detail why your nominee meets the criteria for dedication. Use qualitative feedback or quantitative measurements, if possible. Include testimony from a patient or family member who was helped by this person. Word-for-word feedback should discuss behaviors and actions that model extraordinary care and support, such as

  • Courage, sacrifice, strength, and/or creativity in overcoming the stresses or obstacles associated with caregiving
  • Patience and endurance in helping a patient's life to be improved. Describe details of the patient's life that improved—for example, the patient regained the ability to perform daily functions independently, to return to work, to engage with the community

Other criteria that can support a nomination include

  • Hours of volunteer time providing a person with services
  • Activities that demonstrate commitment for underserved people
  • Actions describing the impact of the nominee's dedication to a person's ability to get access to better care and treatment
COMMITMENT TO THE COMMUNITY

Types of work honored include:

  • Advocating for better care
  • Outreach to underserved populations
  • Activities at the grassroots level
  • Promoting the patient's voice
  • Providing MPN community leadership
  • Creating awareness programs, innovative educational materials, programs, or events, disease management initiatives, research and science-based programs, media outreach, or campaigns

When completing your nomination:

Describe in detail why your nominee meets the criteria for dedication. Use qualitative feedback or quantitative measurements, or examples of other independent recognition, if possible.

Examples include information such as:

  • Number of patients reached through a program, educational material, and/or event
  • Number of media impressions generated through outreach, advocacy, and grassroots efforts
  • Survey data that demonstrate a change in behavior, attitudes, awareness, or policies
  • Peer-reviewed journal articles that support the nominee's commitment to leadership in developing services and programs that address the unmet needs of the MPN population, advancing the science of MPNs, or increasing awareness of unmet needs
  • Other awards or accolades received for the activity nominated
  • Ways the nominee worked to overcome issues and barriers to care, including financial, psychosocial, adherence support, and care assistance
  • Patient or family testimony about how the activity impacted their lives for the better
SHARE THIS LINK
Share

Share an MPN Awareness Badge. Show your support and promote
myeloproliferative neoplasm(MPN) awareness. Share a badge through socail media
with your friends and family. #MPNAAwareness

No Thumbnail
Create A PIN
Board

Share an MPN Awareness Badge. Show your support and promote MPN Awareness!
#MPNAAwareness

No Thumbnail
Thank You For Visiting.

You are now leaving www.VoicesofMPN.com and being directed to a third party Web site. Incyte is not responsible for the content of the site you are about to visit.

Would you Like to continue?