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.

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.

Drop your files here

Recognition Requested by the Following Date

Optional

mm/dd/yyyy

Recognition Requested to Be Presented In Person

Send me a copy of my responses

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