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 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):*Letter of SupportProcure and submit 1 letter of support from a supporter/contributor other than the nominator.Letter of Support - File Upload*Please upload 1 letter of supportAccepted file types: pdf, doc, docx.Lead Nominator InformationNAME OF LEAD NOMINATOR:*LEAD NOMINATOR EMAIL:*LEAD NOMINATOR PHONE:*