2019 Northern Virginia EMS Council Award Nomination For

Outstanding Contribution to EMS

by a High School Senior



This is an offical nomination form for a regional EMS award. Please consider all the following information before you complete the form.

o        Has the nominee met all of the criteria for this award category? If not, please consider another category. Nominees that are incorrectly categorized will not be considered.

o        Do you have supporting materials if the category requires them? Supporting materials should be emailed to northern@vaems.org after you submit this form

o        You will need a high resolution digital photo of the nominee. Photo must be emailed to northern@vaems.org after you complete this form 

o        Will you meet the required deadline for entries?

o        Supporting materials and Photos can be sent after this form is completed.


Please fill out the following information below.

This competitive $1,000 scholarship will be awarded to a high school senior who has been affiliated with an EMS agency within the Northern Virginia EMS Region (Planning District 8) for at least six months, and who is currently enrolled or will be enrolled in an institution of higher learning or an accredited ALS training program in the coming year.

Nominee's Information

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