Award Nominations OSLHA Award Nomination Form This form is used for all professional award nominations. Please remember to send in 2 letters of support to the OSLHA office. NAME OF NOMINEE:*NAME OF OSLHA AWARD:*Honors of the AssociationFellow of the AssociationElwood Chaney Outstanding Clinician AwardNancy Bailey Award of AppreciationAdvocacy Recognition AwardNominee InformationNOMINEE PHONE:*NOMINEE EMAIL:*NOMINEE ADDRESS:*NOMINEE CITY / STATE / ZIP CODE:*Nominee QualificationsPROFESSIONAL MEMBERSHIPS AND NUMBER OF YEARS:*CURRENT POSITION(S):*PREVIOUS POSITION(S):*EDUCATION:*CERTIFICATION:*LOCAL CONTRIBUTIONS/OUTSTANDING CONTRIBUTIONS (including a description of the efforts & the measurable outcome/results):*Letters of SupportLetters of Support - File Upload*Accepted file types: pdf.Please upload 1st letter of supportLetters of Support - File Upload*Accepted file types: pdf.Please upload 2nd letter of supportLead Nominator InformationNAME OF LEAD NOMINATOR:*LEAD NOMINATOR EMAIL:*LEAD NOMINATOR PHONE:* This iframe contains the logic required to handle Ajax powered Gravity Forms.
