Outstanding School Clinician Award Nomination Form

The MSHA Public Schools Committee requests nominations for Outstanding School Speech, Language, and/or Hearing Clinicians to be recognized. Nominations may come from anyone who feels the clinician is deserving of statewide recognition. Additional information may be requested via email (info@mislha.org) prior to determining an individual’s eligibility. The Public Schools Committee will review all nominations and may conduct an interview with eligible nominees.

Eligibility and Guidelines:
It is the intent of the Public School Committee’s Outstanding School Clinician Award to accomplish the following:

Give visible recognition to outstanding speech, language, and hearing clinicians working in public schools in the state of Michigan.
Motivate individuals to provide excellent school based services.
Showcase these clinicians to promote public awareness of the professional practices and services delivered by our professions.
This award is an annual event wherein recognition is given to one or more clinicians. Extensive coverage will be given to the individuals(s) at the MSHA Conference, in MSHA publications and on the MSHA website. A media press release will be distributed.

For purposes of participation in this project, a public school clinician is defined as follows:

Anyone who provides service to individuals (birth to age 26) who have or are at risk of having speech, language and/or hearing impairment within a school setting. This person’s work is guided by ASHA’s professional practices as well as federal (IDEA), state (MARSE and LARA) and local education agency requirements.

Note: This award is not open to clinicians working outside of public schools. Please contact MSHA via email (info@mislha.org) regarding awards recognizing health care programs and clinicians.

Eligibility criteria:
1. The clinician is a current MSHA member and has been for at least 3 years.
2. The clinician is currently practicing in Michigan and has a State of Michigan SLP License.
3. The clinician has been practicing as a Speech Language Pathologist in public schools for at least 5 years.
4. The Clinician has current ASHA CCCs.

The procedure for participating is as follows:

Nominations may be made by anyone - colleague, administrator, student, parent, community member.
Nominations must be submitted via the online form below. Nominations will be reviewed by the Public Schools Committee.

Required documents to accompany nomination form:

Three letters of recommendation, two should come from co-workers or colleagues.
Copy of the clinician’s resume or CV, which should list, among other things, information on:
- Projects and professional practices that demonstrate practicing at the top of the SLP license and ASHA CCC for school-based professions
- Experience working with or supervising students and/or clinical fellows
- Mentorship provided to other professionals/provision of training outside of the field
- Family or community outreach activities
- Membership in other state or national organizations (not including ASHA)
- Service on MSHA Committees or those of other professional organizations
- Offering continuing education and/or professional presentations
- Specialty recognition achieved (e.g., Board Certification from ASHA or awards, excluding continuing education awards)
- Professional publications

Additional information may be requested prior to determining an individual’s eligibility. The Public Schools Committee will review all nominations and may conduct an interview with eligible nominees.

First Name *

Last Name *

Email *

Nominee's information

Clinician's Name: *

Facility: *

Current Michigan License: *

Is the clinician's ASHA C's current? *
Choose 1

Is the clinician's MSHA membership current? *
Choose 1

MSHA Member since: *

Work Phone: *

Cell or Home Phone: *

Address: *

Email Address:
*

Nominator's information:

Nominated by: *

Address: *

Work Phone: *

Cell or Home Phone: *

When would be the best time to contact you if needed? *

Email Address: *

Please use the upload buttons below to upload the following required documents:

Three letters of recommendation, two should come from co-workers or colleagues.
Copy of the clinician’s resume or CV, which should list, among other things, information on:
- Projects and professional practices that demonstrate practicing at the top of the SLP license and ASHA CCC for school-based professions
- Experience working with or supervising students and/or clinical fellows
- Mentorship provided to other professionals/provision of training outside of the field
- Family or community outreach activities
- Membership in other state or national organizations (not including ASHA)
- Service on MSHA Committees or those of other professional organizations
- Offering continuing education and/or professional presentations
- Specialty recognition achieved (e.g., Board Certification from ASHA or awards, excluding continuing education awards)
- Professional publications

Letter of Recommendation #1 *

Letter of Recommendation #2 *

Letter of Recommendation #3 *

Clinician's CV or Resume *

Michigan Speech Language Hearing Association