Regional EMS Award for Outstanding EMS Prehospital Provider Nomination Form

Regional EMS Award for Outstanding EMS Prehospital Provider 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.) Why is the nominee exceptionally qualified and why should they be selected for this award? B.) Explain how this provider exemplifies outstanding dedication, mentorship of the field and investment to his or her community through involvement with EMS.
  • Date Format: MM slash DD slash YYYY