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Michigan
Speech-Language-Hearing Association
Honors and Awards
NOMINATION
FORM
Honors
of the Association
The
Honors of the Association is the highest recognition MSHA can award an
individual.
The Honors of the Association recognizes sustained, outstanding
accomplishments in the profession of speech, language and hearing.
The Honors of the Association is conveyed to individuals who actively
demonstrate their expertise through ongoing service which directly benefits MSHA
and the field as a whole, and has a significant impact on persons with
communication impairments.
The Honors of the Association is considered a coveted and earned award
given to truly deserving professionals
I.
NAME OF NOMINEE:
Address:
Phone:
W: (
)
H: (
)
Present
position/Employer:
Highest
degree
Year
Institution
MSHA
Status: Active
Life
Non-Member
II.
ENCLOSED MUST BE:
Nomination form
Written rationale for nomination
for Honors of the Association (not to exceed four typed, double-spaced pages)
Current vita of the nominee
Five (5) letters of
recommendation (at least two (2) from MSHA members in good standing)
At least the minimal 70 points
to qualify for nomination on the Criteria Form
III.
SUBMITTED BY:
Address:
Phone:
W: (
)
H:
(
)
Present
position:
MSHA
Status: Active
Life
Non-Member
lV. SIGNATURE (of nominator)
This form and all supporting material should be received by the MSHA office by November 1st. Send to: MSHA, 790 W. Lake Lansing Rd. Ste. 500-A, East Lansing, Michigan 48823
(517) 332-5691 or FAX: (517) 332-5870.
