2021 Trauma Leadership Award Nomination Form

DUE September 15, 2020

This award is presented to an individual, in the medical or non-medical field, who has demonstrated outstanding leadership in trauma through practice, research, publication, education, patient advocacy, injury prevention, trauma system development or legislative involvements during their career at a local, state or national level.

Nominations must include a current CV to be considered. Please have CV ready to upload before completing the form.

Those not eligible are current members of the STN Board of Directors, any individual who has served on the STN Board of Directors in the past year, and any Leadership Award winner who received the award in the past three years.

Nominee Information

I recommend the following individual for the STN Leadership Award:


*First Name:
*Last Name:
*Credentials:
Title:
Company/Facility:

*Address 1:
Address 2:
*City:
*State:
*Zip:

*E-Mail Address:
*Phone:

*Is the candidate an STN member?
*Candidate's approximate number of years' experience in trauma:

Nominator Information

Please tell us about yourself.

*First Name:
*Last Name:
Title:
Company/Facility:

*Address 1:
Address 2:
*City:
*State:
*Zip:

*E-Mail Address:
*Phone:

Describe in detail how this candidate has shown outstanding leadership in trauma.

If this candidate's work has been primarily at a local or state level, how has the impact been felt on a national level, directly or indirectly.

Include a copy of the nominee's Curriculum Vitae (CV) with the nomination. (doc, docx, pdf).