PEMS Regional EMS Award for Outstanding EMS Prehospital Educator Nomination Form


Criteria for this award:  A provider 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.  Education programs include: EMR, EMT, AEMT, Intermediate, Paramedic, continuing education courses, preceptor programs or equivalent EMS training.

Eligibility for this award:  A Virginia EMS Educator.

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 nominee enhanced EMS education for their students and why should the nominee be selected for an award?*
Explain how this provider exemplifies outstanding teaching and leadership qualities while participating as an educator in an EMS program.*
Explain how this educator goes above and beyond to assist students and agencies in the completion of their training.*
How do they enhance the classroom or training experience to ensure that their students are ready and can provide the best care to their patients?*
Does this educator sit on any committees or participate with programs that help to further enhance EMS education and patient care?*
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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