AMTC Community Awards Nomination Worksheet
PLEASE NOTE: YOU CANNOT SUBMIT THIS WORKSHEET AS A NOMINATION.
To prevent losing your work in the event your nomination submission does not go through, this
worksheet will allow you to save your answers to all of the questions on the awards nomination form.
You can find the online nomination form here.
Directions
1. *Review all awards’ descriptions and judging criteria: Online | PDF (Pg. 4-7)
2. *Review all of the award nomination general policies: Online | PDF (Pg. 1-2)
3. *After completing your nomination form submission, please look in your inbox for a
confirmation email. If you do not receive a confirmation email, please immediately contact Elena
Sierra at esierra@aams.org.
4. Awards Nominations FAQs
Q.) What does the winner receive?
A.) Award Winners will each receive funding for one person to travel to Air Medical Transport
Conference (AMTC).
Q.) When will I receive notification of the judging results?
A.) Four to six weeks after the award nomination deadline listed above.
Q.) How can I write a winning award nomination?
A.) You can download our guide Keys to a Well-written Nomination Guide.
Q.) Where can I find the history of past award winners?
A.) Historical Award Winners List
Q.) I do not see the award option on the form that I would like to submit a nomination for… are there
other awards?
A.) Yes, there are awards not listed on the award nomination form. For the Vision Zero Award, you can
click here for more information. You can also find out more information on our AMTC partner
associations’ other awards online at:
– Air Medical Physician Association (AMPA)’s Medical Director of the Year;
– Air & Surface Transport Nurses Association (ASTNA)’s Katz-Mason Award & Jordan Award;
– International Association of Flight and Critical Care Paramedics (IAFCCP)’s Tim Hynes
Award;
– National Association of Air Medical Communication Specialists (NAACS)’s Communicator of
the Year Award;
– National EMS Pilots Association (NEMSPA)’s Pilot of the Year Award.
Q.) I have additional questions, who should I contact?
A.) Please contact AAMS Membership Manager Elena Sierra at esierra@aams.org.
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Page 2 Online Nomination Form –
15 Required* Questions with a total of 28 questions located on this form. (5 Pages Total in Worksheet)
1. Which AMTC Community Award are you submitting a nomination for?* Select One
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Program Director of the Year
Neonatal & Pediatric Transport Award of Excellence
Critical Care Ground Award of Excellence
Fixed Wing Award of Excellence
Transport Mechanic’s Award of Excellence
Barbara A. Hess Research & Education Award
Jim Charlson Aviation Safety Award
Marriott-Carlson Lifetime Achievement Award
Program of the Year Award
Please Note: 1st option listed above is for PROGRAM DIRECTOR. The last option listed above is for PROGRAM of the YEAR. Thank you!
2. Have you read the judging criteria for this award? * Check Box
_______ Yes | All awards descriptions and judging criteria: Online |PDF (Pg. 4-7)
3. Have you read the award nomination policies? * Check Box
_______ Yes | All awards nomination general policies: Online | PDF(Pg. 1-2)
Nominee's Information
4. Your Nominee's Name*
_______________________________________________________________________________
5. You're Nominating...* Select One
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A Transport Program or A Company
An Individual
6. For a transport program/company nominee: Who is the Main Contact? Please provide their name below.
_______________________________________________________________________________
If you're nominating an individual, please leave this field blank. If you do not know who the main contact is, please type "I do not know" in the
above field.
7. Nominee's Daytime Phone Number:
_______________________________________________________________________________
If you do not know it, you can leave this field blank.
8. Phone Type - Select One
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Cell Phone
Direct Office Line
Main Office Line
9. Nominee's Email:
_______________________________________________________________________________
If you do not know it, you can leave this field blank. The nominee will NOT receive an email confirmation. Only the nominator will receive a
confirmation email.
Page 2 of 5
About Your Nominee
You can see all awards’ descriptions and judging criteria: Online | PDF (Pg. 4-7)
10. Is your nominee a member of AAMS?* Select One


Yes
Unsure
If you are unsure, please select that option above. AAMS will follow-up with you to let you know your nominee's membership status. AAMS
reserves the right to refuse acceptance of any non-member nomination.
11. Have you provided in your nomination's cover letter: The number of years the program/company has been
operating in our industry; or for an individual nominee, have you provided the number of years that they have worked
in our industry, and years that they have been in their current role/position?* Check Box
_______ Yes
12. Have you provided in your nomination's cover letter: CAMTS Accreditation? And for which modes of transport
the program has received accreditation?* Select One
 Yes, I have provided the appropriated CAMTS Accreditation information in my nomination's cover
letter.
 No, my nominee is an individual - or - my company nominee is not a transport program
13. In the last 5 years, has your nominee had an accident or crash?* Select All Applicable
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The nominee had an accident in the last calendar year.
The nominee had a crash in the last 5 years.
The nominee has been accident FREE in the last calendar year.
The nominee has NOT had a crash in the last 5 years.
My company nominee is not a transport program.
My nominee is an individual, not a transport program.
Select all statements that apply to your nominee. A transport program with an accident in the last 12 months will automatically be disqualified. A
program with a crash in the last 5 years will automatically be disqualified.
14. In 500 characters or less, what is the main reason behind you nominating this nominee for this award? *
Please cover the overall impact of the program/company/individual’s effort(s) and whether the impact was felt on the
program, community and/or national level. You may expand on this point in your nomination's cover letter.
PLEASE CONTINUE TO PAGES 4-5
Page 3 of 5
Upload Cover Letter & Supporting Document(s)
You can see all awards nomination general policies: Online | PDF(Pg. 1-2)
Required - Nomination's cover letter: should be no more than 2 single-spaced pages of information (or 7,100 characters with spaces)
explaining why the nominator believes his/her nominee deserves the award.
Optional - Other supporting documents such as letters of support or testimonials: shall not exceed one-page in length and no more
than three letters of support/ testimonials will be accepted.
Optional - You are also limited to 1 additional supporting document or visual that demonstrates impact of effort(s) done by a nominee
(such as a resume, poster, PowerPoint Slides, PDF Document, Excel Document, or web page, etc.). This document cannot exceed five
pages (or slides) in length.
Please include reference to your nominee when naming your supporting documents for upload.
Examples: "Smith_cover_letter", "MEDSTAR_Cover_Letter", etc.
15. Please Upload Your REQUIRED Nomination's Cover Letter *
Accepted Doc Types: PDF,DOC,DOCX - This document should be no more than 2 single-spaced pages (or 7,100 characters with spaces).
16. Please Upload Your Nomination's 1st OPTIONAL Letter of Support or Testimonial Here:
Accepted Doc Types: PDF,DOC,DOCX - This document shall not exceed 1 page in length.
17. Please Upload Your Nomination's 2nd OPTIONAL Letter of Support or Testimonial Here:
Accepted Doc Types: PDF,DOC,DOCX - This document shall not exceed 1 page in length.
18. Please Upload Your Nomination's 3rd OPTIONAL Letter of Support or Testimonial Here:
Accepted Doc Types: PDF,DOC,DOCX - This document shall not exceed 1 page in length.
19. Please Upload Your Nomination's OPTIONAL Visual or Example Here:
Accepted Doc Types: jpg,jpeg,gif,bmp,tif,pdf,doc,docx,xls,xlsx,mp3,mp4,zip - Video Files please upload to YouTube and provide link in the next
field on this form. This document shall NOT exceed 5 pages in length, please be considerate on the overall file size of this document.
20. If you would like to provide a web link instead of uploading a visual document, you can provide that
hyperlink and its description here:
_______________________________________________________________________________
Ex., A web link to a YouTube Video
21. If you have any concerns about any of the documents you're uploading, please let us know here:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Win or Lose....
22. In the event that your nominee wins this award: What is the city and state of your nominee that you would like
printed on the trophy and/or other awards materials?
_______________________________________________________________________________
If you do not know at this time, please write, "I do not know" in the above box
23. In the event that your nominee wins this award: Who would be the contact person in charge of coordinating the
collection of photos and video clip(s) for the production of the award's video that will be played at the AMTC
Community Awards Show?* Select One
 You- The Nominator
 The Nominee, please use the contact information I have provided for them above.
 I Don't Know Who It Will Be
 Other: ______________________
About You - The Nominator
24. Your Name*
___________________________________
First Name
___________________________________
Last Name
25. Your Program's / Company's Name
_______________________________________________________________________________
If not applicable, you can leave this field blank.
26. Your Email*
_______________________________________________________________________________
27. Your Cell Phone*
_______________________________________________________________________________
Required
28. Your Office Phone
_______________________________________________________________________________
Optional
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