Maryland Stars of Life Awards 2025 Application

Maryland Stars of Life Awards 2025 Application

MIEMSS is accepting nominations for the 2025 awards. 2025 nominations are for actions taking place between January 1, 2024 through December 31, 2024. Nominations for the 2025 awards will be accepted on a rolling basis with a final DUE date of Friday, March 28, 2025. Nomination Guidelines are located at: https://www.miemss.org/home/Public/Awards

Indicate the time period during which the action(s) took place for this nomination.

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PERSON SUBMITTING THIS NOMINATION

Full Name*

Submitter's Affiliation/Organization*

Full Address*

Email*

Telephone (Work)*

Mobile Phone*

Fax No.

AWARD / NOMINATED INDIVIDUAL(S) / ORGANZATION(S)

Award Category*

If there is more than one nominee associated with the same incident or activity, please DO NOT duplicate this form but rather list names, affiliation, and contact information on a separate sheet of paper and attach to this form.

Select

Individual(s) / Organization Name(s) Nominated*

If there is more than one nominee, please duplicate this form or use a separate sheet for the other names and addresses and attach it to this form

Address*

P.O. Box or Street

City*

State*

Postal Code*

Telephone (Home)*

Telephone (Work)*

Telephone (Cell)*

E-mail*

Certification Level*

Professional Affiliation*

Date of Activity or Incident*

Location of Activity or Incident*

This individual/group/program/facility is being nominated for outstanding recognition because:*

[Minimum word count 500; Maximum word count 1000] If applicable, please submit additional documentation such as newspaper articles, video footage, and audio recordings and letters of commendation.

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