2018 EMS Award Nomination Form

Thank you for taking the time to submit a nomination for the 2018 NJ EMS Awards!

Please be sure to join us for the 2018 NJ EMS Awards Program on October 5, 2018 during the National Conference on EMS in Atlantic City.

ALL NOMINATIONS MUST BE RECEIVED BY:
MONDAY July 31, 2018 AT 5:00 pm
Please choose an award nomination category:

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* 1.
Please choose an award nomination category:

LAST NAME or AGENCY NAME of whom you are nominating:

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* 2. LAST NAME or AGENCY NAME of whom you are nominating:

FIRST NAME of the person whom you are nominating

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* 3. FIRST NAME of the person whom you are nominating

Contact Information of the person or agency the your are nominating:

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* 4. Contact Information of the person or agency the your are nominating:

***For "Outstanding EMS Call" ONLY***  Additional Crew Member 2 (if applicable)

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* 5. ***For "Outstanding EMS Call" ONLY***  Additional Crew Member 2 (if applicable)

***For "Outstanding EMS Call" ONLY***  Additional Crew Member 3 (if applicable)

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* 6. ***For "Outstanding EMS Call" ONLY***  Additional Crew Member 3 (if applicable)

Your contact information. This information is needed in the event that the committee needs further clarification, or if they are unable to notify the person or agency that your are nominating.

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* 7. Your contact information. This information is needed in the event that the committee needs further clarification, or if they are unable to notify the person or agency that your are nominating.

MUST BE A MINIMUM of 300 WORDS:    Please describe, in detail, why you feel this person or agency deserves to receive this award based on the category description listed on the conference website. Please be as descriptive as possible as this is the only information the awards committee will have to evaluate your nomination.  You may cut and paste your text into this box.  

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* 8. MUST BE A MINIMUM of 300 WORDS:    Please describe, in detail, why you feel this person or agency deserves to receive this award based on the category description listed on the conference website. Please be as descriptive as possible as this is the only information the awards committee will have to evaluate your nomination.  You may cut and paste your text into this box.  

Please note:
For the "Outstanding EMS Call" category, a maximum limit of 3 nominees can be included in a single nomination. ALL NOMINEE INFORMATION MUST BE LISTED IN THE CREW MEMBER FIELDS ABOVE. Incomplete, mislabeled, or nominations that do not meet the award description or criteria, will be disqualified. The Department and/or Awards Committee reserves the right to disqualify or reassign a nomination to another category as appropriate.

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