Years of Service Award Nomination Form | CLINIC

Years of Service Award Nomination Form

Due by May 2, 2017

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, May 26, 2017. 

Nominees must have completed exactly 5, 10, 15, 20, 25, or 30 years of service by May 2, 2017, and must be present at the Convening.

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

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