PEMS Regional EMS Award for Excellence in EMS Nomination Form


Criteria for this award:  An individual who exemplifies outstanding dedication and service to the statewide Virginia emergency medical services system, and has demonstrated a commitment to a comprehensive, integrated system of emergency medical services throughout the Commonwealth.

Eligibility for this award:  Any individual engaged in emergency medical services.

Name of Nominee:*
Nominee Agency or Organization:*
Nominee Phone:*
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Nominee E-mail:*
Address of Nominee:*
Submitter Information
Submitted by:*
Submitter E-mail:*
Submitter Phone:*
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Brief Abstract of Nominee:
How has this person/program/agency exemplified outstanding dedication and service to the statewide Virginia emergency medical services system?*
Why is this nominee exceptionally qualified for this award?*
How has this person/program/agency demonstrated a commitment to a comprehensive, integrated system of emergency medical services throughout the Commonwealth?*
Provide a description of the successes and accomplishments of this person or agency in EMS, to include honors, awards (civic or professional) that highlight their contribution to EMS and the community.*
Supporting Documents:
Upload High Resolution Photographs of Nominee:
Letters of Recommendation:
Resume/CV:
Other supporting documents (newspaper/periodical articles, press releases, etc.)
Ready to submit?

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