Regional EMS Award for Outstanding Contribution to EMS Telecommunication

Regional EMS Award for Outstanding Contribution to EMS Telecommunication NOMINATION FORM

  • If nominating an agency, please include the agency license number here.
  • 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
    Max. file size: 100 MB, Max. files: 3.
    • A.) Describe how this person’s outstanding dedication and service has demonstrated an exceptional contribution to the improved delivery of emergency medical services in the local, regional or statewide EMS system. B.) Are there any programs or events that they have implemented or educational programs that they have created or enhanced? C.) Does this nominee provide any other volunteer or career services with the EMS system?
    • A.) Does this nominee sit on any committees or participate with any groups that help to enhance and advocate for EMS and/or telecommunications?
    • Accepted file types: jpg, jpeg, png, gif.
    • MM slash DD slash YYYY