EMS Division -- Special Recognitions

EMS Division -- Special Recognitions

The IDHS EMS Division recognizes Hoosiers in various categories. Complete this form to nominate someone in the EMS field for one of the EMS recognitions. List of recognitions with their descriptions and guidelines: https://www.in.gov/dhs/files/EMSC-Special-Recognition-Guidelines.pdf

Type of Recognition*

Select all that apply.

Select

Nominee's Name (as it should appear on the recognition)*

Nominee's Job Title or Position

Nominee's Primary Agency or Department

Nominee's PSID Number (if known)

The PSID number is the EMS certificate or license holder's unique identifying number.

Your Title*

Example: EMS Director, Shift Leader

Your Relationship to Nominee*

Your Name*

Your Email Address*

Your Phone Number*

Description of Nomination*

Use this field to describe why you are nominating the recipient for recognition by the EMS Section. If the description is lengthy, please use the following File Upload section to attach a file containing the full description and any supporting documentation.

File Upload

Optional: Upload supporting documentation, such as recommendation or testimonial letters, EMS certificate or EMS license numbers, eyewitness accounts, etc.

Drag and drop files here or

Recognition Requested by the Following Date

Optional

Recognition Requested to Be Presented In Person

Select

Details of In-Person Presentation

If requesting an in-person presentation, please describe the event or gathering (if applicable), including time, date and place.

Send me a copy of my responses

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