Practitioner of the Year Award form 1 Introduction2 Nominee’s Information3 Nominator’s Name and Credentials4 Upload Nominee Practitioner of the Year Award The TSRC Board of Directors (BODs) would like to extend an invitation to nominate someone for the Practitioner of the Year Award! The BODs will be accepting nominations for the following nine (9) categories. Adult Acute Care Home Care Continuing Care / Rehabilitation Transport Leadership Sleep Neonatal / Pediatrics Education Diagnostics Criteria: All nominees must be an active member of the AARC (verification by AARC#).All nominees must hold an active Texas Respiratory Care Practitioner’s License (verification from TMB license #).There must be at least two (2) nominees for each specific specialty category to move forward with an award. Application deadline is May 1. Nominee’s InformationNominee’s Name* First Last Nominee’s Credentials AA AAS AS BA BHS BS BSEd BSN BSRC BSRT DHSc EdD JD MA MBA MEd MHA MHS MPA MPH MS MSEd MRC MSRC MSA MSJ MSN PhD Other Other credentials*Nominee’s Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominee’s Email Nominee’s PhoneNominee’s EmployerAARC NumberTexas RCP License #Specialty Category*DiagnosticsHome CareAdult Acute CareTransportSleepContinuing Care/ RehabilitationLeadershipNeonatal/ PediatricsEducation Upload the letter of recommendation and resume or CV of nomineeNomination Letter of Recommendation*Accepted file types: pdf, docx.Only PDF or Word documents may be uploaded. The nomination letter (no more than one page) is to include the at least the following information: Leadership skills Mentorship Team building Clinical expertise Professionalism Community involvement / volunteer Nominee’s Resume or CVAccepted file types: pdf, docx.Only PDF or Word documents may be uploaded. Nominator’s Name*If nominating self, write in “self - nomination.” First Last Nominator’s Email* Enter Email Confirm Email Nominator’s PhoneProcess of deciding the award winners: Once all required information is received, the nominee will be contacted of their nomination. The TSRC BOD will review all nominations and vote. Winners will be contacted in May. Practitioners of the Year will be recognized by the TSRC President during the Awards Ceremony on September 30. PhoneThis field is for validation purposes and should be left unchanged.