Oregon Athletic Trainers’ Society
Awards Nomination Form

Nominator:_____________________________

Home Phone:___________________________Office Phone:______________________

Email Address:__________________________

Award Nomination : (check one)

__ OATS Outstanding Service Award
__ OATS Educator Award

Nominee:____________________________ NATA Cert. #:_______________________

Years of OATS Membership:____________ Years of NATA Membership:___________

Home Address:________________________Office Address:______________________

Home Phone:_________________________ Office Phone:_______________________

Email Address:___________________________________________________________

Summary Statement and justification of support for this award:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(Feel free to use another page if more room is needed)