Years of Service Award Nomination Form | CLINIC

Years of Service Award Nomination Form

During the Annual Convening, CLINIC will recognize the commitment and dedication of affiliate staff members who have served in your organization for five or more years. Staff members will be honored at the Awards Luncheon on Friday, June 1, 2018. 

Nominees must have completed exactly 5, 10, 15, 20, 25, or 30 years of service by Tuesday, May 1, 2018, and must be present at the Convening. We will accept submissions no later than May 1, 2018

Please complete a separate form for each individual from your agency.

Files must be less than 5 MB.
Allowed file types: gif jpg png.