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*Please upload 1st letter of supportAccepted file types: pdf, doc, docx.Letters of Support - File Upload*Please upload 2nd letter of supportAccepted file types: pdf, doc, docx.Lead Nominator InformationNAME OF LEAD NOMINATOR:*LEAD NOMINATOR EMAIL:*LEAD NOMINATOR PHONE:* This iframe contains the logic required to handle Ajax powered Gravity Forms.
