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FLASHA Awards Nomination Form: Clinician of the Year

Clinician of the Year

CLINICIAN OF THE YEAR

Clinician of the Year shall be awarded to an individual who has demonstrated outstanding professional behavior and recent personal achievement in the field.  This individual will be our Florida Nominee for ASHA’s DiCarlo Award. Types of activities may include, but are not limited to: achievement with a single client or group of clients; program development; achievement in a state or local organization or government agency activity; clinical teaching, research or administration.
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