NCSHLA Awards Center > Clinical Acheivement

NCSHLA Awards Center

2010 State Clinical Achievement Award

Complete the form below to submit your nomination. Copies of the nomination will be transmitted to NCSHLA and to the Chair of the NCSHLA Membership & Recognition Committee. Contact headquarters at (919) 833-3984 or by email info@ncshla.org with questions.


2010 State Clinical Achievement Award
Submission deadline is Jan. 15, 2010
I wish to nominate—
Name:
Address:
 
Degree:
Title:
Workplace:
Nominator Info—
Your Name:
Your Address:
 
Your Telephone:
Fax Number:
Email Address:
Title/Position:
Workplace:
A. Identification and description of the outstanding clinical achievement, including information on when and where the specific achievement(s) took place.
B. Description of the significance of the achievement.
C. Explanation of how the nominee's actions have advanced knowledge in clinical practice.
D. Explanation of the nominee's role in the achievement.
   
The North Carolina Speech, Hearing & Language Association
PO Box 28359 • Raleigh, NC 27611-8359
Tel: 919-833-3984 · Fax: 919-832-0445

Privacy Policy | Advertising Info

Last update on: 10/1/2009