President’s Award Nomination Form – Occupational Therapy Association of Oregon

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The purpose of the President’s Award is to recognize an OTAO member who has consistently contributed/supported the OTAO President in their leadership role, to better meet the needs of our OT practitioners. Award candidates may be an OT, OTA, or an OT/OTA student.

Name *

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Last

Person Nominating Candidate

Title/Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Name *

First

Last

President's Award Candidate

Award Candidate's Title/Organization *

Award Candidate's Address (if known)

Award Candidate's Phone (if known)

Award Candidate's Email *

Please provide descriptive statements providing information regarding the nominee's contributions and actions which have markedly benefitted the OTAO President. Please include information that can be used to assist in presenting this award to the selected candidate(s). *

Type your responses here. For more information, please contact us at info@otao.com

Name

FOR MORE INFORMATION:

Occupational Therapy Association of Oregon
Phone: (971)266-4328
Email: otaoinfo@gmail.com