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FLASHA Awards Nomination Form: School Clinician of the Year

School Clinician of the Year

SCHOOL CLINICIAN OF THE YEAR

School Clinician of the Year shall be awarded to an individual in recognition of exemplary commitment and contribution to the delivery of Audiology and/or speech-language pathology services within a school setting.  This individual will be our Florida nominee for the ASHA’s Van Hattum Award.  Eligible activities may include, but are not limited to: the conduct of exemplary clinical services, supervision or research; the development of an innovative program with emphasis on those that are replicable; the promotion or enhancement of public or private support for speech-language pathology and audiology services in the schools.
1.Name of Nominee
2.Nominee Telephone Number
3.Nominee Email Address
4.Mailing Address
5.Present Position & Employer
6.Highest Degree Attained
7.Year Attained
8.Nominee's FLASHA Member Status
9.Briefly explain why this nominee should receive this award (750 words maximum). You should include identification and description of the outstanding achievement(s) (including date and location of the occurrence(s) if known), a description of the significance of the achievement(s), and an explanation of the nominee's role in the achievement(s).
10.Nomination Submitted By
11.Telephone Number
12.Email Address
13.Present Position & Employer
14.FLASHA Member Status