PEMS Regional EMS Award for Outstanding EMS Leadership (Formerly named Outstanding EMS Administrator) Nomination Form


Criteria for this award:  An individual who has demonstrated ability to organize, conduct, manage, problem solve and evaluate within his or her organization and, by exemplary leadership and administrative skills, improve the effectiveness, response and delivery of EMS.


Eligibility for this award:  Any person responsible for chairing, presiding over, supervising or administering EMS organizations and/or personnel in Virginia.

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 individual demonstrated an ability to organize, conduct, manage, problem solve and evaluate within his or her organization?*
How has this individual, through exemplary leadership and administrative skills, improved the effectiveness, response and delivery of EMS?*
Describe the nominee’s qualities and contributions to EMS in Virginia as a leader and administrator*
How has this nominee enhanced EMS for their agency, region or the state?*
Does this administrator sit on any committees or participate with programs that help to further enhance EMS and patient care?*
Supporting Documents:
Upload a 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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