2026 WEMSA Excellence in Service Awards Nomination Form

2026 WEMSA Excellence in Service Awards Nomination Form

Nominations must be submitted by September 30, 2026!
WEMSA's Annual Excellence in Service Awards are a way for us to honor both individuals and organizations who have made a significant contribution to the EMS profession in the past year. Please refer to the WEMSA website for all eligibility requirements per award.
Select the Award for which you are submitting:
Does the nominee know this nomination has been submitted or would you prefer it to be kept confidential until winners are announced?
Nominees Contact Information
Nominee's Name

First NameLast Name
Nominee's Email
example@example.com
Nominee's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Nominee's Current EMS Agency/ Employer
Your Contact Information
Are you the Nominee's Supervisor/ Chief?
Your Name

First NameLast Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Current EMS Agency/ Employer
Supervisor/ Chief's Information

As part of the vetting process we will contact the nominee's Supervisor/ Chief. Please enter the Supervisor/ Chief's contact information.
Supervisor's Name

First NameLast Name
Supervisor's Email
example@example.com
Supervisor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor's Title
How does the Nominee's Supervisor prefer to be contacted?
Secondary Reference's Information

As part of the vetting process we may contact a secondary reference to support the nomination. Please enter a secondary reference's contact information if you wish to do so.
Would you like to include a secondary reference other than the Supervisor/ Chief that you listed above?
Secondary Reference's Name

First NameLast Name
Secondary Reference's Email
example@example.com
Secondary Reference's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How does the Secondary Reference prefer to be contacted?
Supporting Documentation

You will be required to submit a nomination statement along with this form for the nomination to be complete. To support your nomination, you may also attach up to 3 Supporting Documents, but these are not necessary for completion of the nomination.
Attach your nomination statement- 1,000 words or less (see award winner attributes on the WEMSA website for what should be included on your statement)

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Supporting Document #1

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Supporting Document #2

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Supporting Document #3

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Local Media Contacts to whom press releases should be sent

If you would like to provide a media contact or publication contact in your local area that we should send a press release to if your nomination is chosen for an award, please include that information below
Publication Name
Reporter's Name
Media Agency's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agency or Reporter's Email
example@example.com
Should be Empty:

2026 WEMSA Excellence in Service Awards Nomination Form

Nominees Contact Information

Your Contact Information

Supervisor/ Chief's Information

Secondary Reference's Information

Supporting Documentation

Local Media Contacts to whom press releases should be sent