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FLASHA Awards Nomination Form: Clinical Career Award

Clinical Career Award

CLINICAL CAREER AWARD

Clinical Career Award shall be awarded to an individual in recognition of outstanding contributions to clinical science and practice in communication science and disorders over a 20 year or longer period.  This individual will be our Florida nominee for ASHA’s Kleffner Clinical Career Award.  The lifetime contributions may have been in clinical service, supervision or administration of clinical service, clinical research, or any other activity which has promoted excellence in clinical service.
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