Service Award Nomination Form – Occupational Therapy Association of Oregon

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The purpose of this award is to recognize members of OTAO who have provided service to the Association through time, task, or talent. The nominee shall be an OT, OTA, OT/OTA Student , and member of OTAO, who has provided at least 30 hours of service to OTAO during the past year.

Name *

First

Last

Person Nominating Candidate

Title/Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Name *

First

Last

Service 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 recipient's contributions and/or services which have markedly benefited the profession of occupational therapy. Please include committee, special task force information or board responsibilities to assist in presenting this award.

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

Phone

FOR MORE INFORMATION:

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