Regional EMS Award for Outstanding Contribution to EMS for Children Nomination Form

Regional EMS Award for Outstanding Contribution to EMS for Children NOMINATION FORM

  • Read each statement below carefully and answer completely. Limit documentation to the information requested. Up to three documents may be attached to the nomination form. Of these items, one letter of support written by someone other than nominator must be included. Other documents may include a resume or CV, a newspaper article written about the nominee, etc.
  • Drop files here or
  • A.) How does this individual or organization exemplify outstanding dedication and service to EMS for Children? B.) Describe this individual or organization’s services, which cover a continuum of care from injury prevention to prehospital care, emergency department and hospital services and rehabilitation.
  • A.) Do they participate in programs or committees for EMS for Children? B.) Have they been recognized for their programs or dedication to EMS for Children locally, regionally or statewide?
  • Date Format: MM slash DD slash YYYY