2021 Pediatric Champion of the Year Award Nomination Form

Wednesday, May 19, 2021 is National EMS for Children Day.

In honor of this special day, the Wisconsin EMS for Children Program is now accepting nominations for the 2021 Pediatric Champion of the Year Award.

This award is granted to an EMS crew or station that has displayed outstanding care for a child in a medical emergency or trauma event, demonstrated exceptional effort in influencing the development of pediatric training or quality improvement programs, or worked toward creating injury prevention efforts.

To submit an application for the Pediatric Champion of the Year Award please complete the below form by April 16, 2021. To be eligible, the event or program must have occurred in the 2020 calendar year. 

Contact Erica Kane at ekane@chw.org or 414-337-4572 with questions. 

Question Title

* 1. Please identify the selection that best describes your nomination:

Question Title

* 2. Please identify the selection that best describes your nominee:

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