Regional EMS Award for Outstanding Prehospital Educator

CRITERIA: An individual who exemplifies outstanding teaching and leadership qualities while participating as an educator in an EMS program. Must have coordinated or consistently demonstrated excellence and a dedication to the education of prehospital EMS providers. The nominee must have participated as an instructor, coordinator or adjunct faculty in an EMS program for at least two years. Educational programs include: First Responder, EMT-B, EMT Enhanced, EMT Intermediate, EMT Paramedic, continuing education courses, preceptor programs or equivalent EMS training.

ELIGIBILITY: A physician, nurse, healthcare provider or certified Virginia EMS educator

Select Award Category*

Award for Outstanding EMS Prehospital Educator

Select Regional EMS Council*

Nominee Name*

Nominee Address*

Nominee Email*

Work Phone

Cell Phone*

Agency Affiliation*

Nominee Certification Number

Position

Nomination Submitted By*

Address

Email*

Work Phone

Cell Phone*

DOCUMENTATION SUPPORTING NOMINATION

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.

Supporting Documentation

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Max. file size: 100 MB, Max. files: 3.

1. Brief Abstract of Person being Nominated: Summarize and justify why this person should receive this award. You are encouraged to consider the following questions when providing your response to this section.*

a.) Why is this nominee exceptionally qualified and selected for this award? b.) How has this person exemplified and demonstrated a commitment to a comprehensive, integrated education system of emergency medical services throughout the Commonwealth?

2. Success & Accomplishments in EMS: Provide a description of the successes and accomplishments of this person in EMS, to include honors, awards (civic or professional) that highlight their contribution to EMS education.*

a.) Does this educator serve on any committees or participate with programs that help to further enhance EMS education and patient care in their local, regional, state, and national EMS groups or committees? B.) Does this educator sit on any committees or participate with programs that help to further enhance EMS education and patient care?

Photo Required: A photo of the nominee must be included. Try to send a color photo (with good lighting) with just the nominee in it. If it is an agency or organization, the photo can be a group shot of agency members, a picture of agency headquarters or a logo.*

Accepted file types: jpg, jpeg, png, gif.FileDescription

To verify the accuracy of the information provided in this nomination form, please type your First and Last Name, along with the date that you submitted this nomination form.

Nominator's Name*

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Date*

Regional EMS Award for Outstanding EMS Prehospital Educator NOMINATION FORM