2017 EMS Instructor of the Year Nomination
Use this form to nominate someone for the 2017 EMS Instructor of the Year Award
Name of Nominee:
Nominee Contact Information (email)
Describe the personal continuing education activities undertaken by the nominee to prepare for the optimal education of others:
Describe the nominee's activities directly related to the education of EMS personnel:
Describe the nominee's community service activities NOT directly related to EMS:
Provide at least two examples of the nominee's effort to promote public awareness of EMS through education:
Explain why you believe the nominee should receive this award:
Provide any additional supporting comments:
Please email two letters of support for this nominee (from two other Instructor-Coordinators) to
I understand that I must email two letters of support from two other ICs to
by January 12, 2018.
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