Award Nominations OSLHA Award Nomination Form This form is used for all professional award nominations. Please note you are asked to include 1 letter of support with your submission!NAME OF NOMINEE:*NAME OF OSLHA AWARD:* Honors of the Association Fellow of the Association Elwood Chaney Outstanding Clinician Award Nancy Bailey Award of Appreciation Advocacy Recognition Award Student Recognition AwardNominee InformationNOMINEE PHONE:*NOMINEE EMAIL:*NOMINEE ADDRESS:*NOMINEE CITY / STATE / ZIP CODE:*Nominee QualificationsPROFESSIONAL MEMBERSHIPS AND NUMBER OF YEARS:*CURRENT JOB TITLE/POSITION(S):*HiddenPREVIOUS JOB TITLE/POSITION(S):*EDUCATION:*CERTIFICATION(S):*LOCAL CONTRIBUTIONS/OUTSTANDING CONTRIBUTIONS:*Please explain why this nominee is an outstanding candidate for this recognition and include a description of the efforts & the measurable outcomes/results that contribute to the award recognition being considered.Letter of SupportProcure and submit 1 letter of support from a supporter/contributor (other than the nominator) who affirms the nominees contributions and/or provides additional evidence to support the nomination.Letter of Support - File Upload*Please upload 1 letter of supportAccepted file types: pdf, doc, docx, Max. file size: 10 MB.Lead Nominator InformationNAME OF LEAD NOMINATOR:*LEAD NOMINATOR EMAIL:*LEAD NOMINATOR PHONE:*Δ