Nova Scotia College of Medical Laboratory Technologists

Urram Award Application

(To be completed by the NSCMLT member proposing nomination)

Personal Data of Nominee

Name
Invalid Input
Address
Invalid Input
City
Invalid Input
Province
Please select a province
Postal Code (A1A 1A1)
Please type your postal code in the following format: A1A 1A1.
Home Phone (123-456-7890)
Please type your phone number in the following format: 123-456-7890
NSCMLT #
Please enter a NSCMLT#
Email
Invalid Input
Complete applicable Contributions(s):
Administrative
(continued commitment to leadership, education and operational efficiency within their organizations, and who provide meaningful contributions to their employers.)
Invalid Input
Educational
(develop personal knowledge & skills, share knowledge and promote learning)
Invalid Input
Professional
(promote integrity, honesty, respect, and ethical professional practices)
Invalid Input
Promotional
(promote image and status of profession, active support of professional body)
Invalid Input
Scientific
(develop methods, procedures or process that contribute to significant improvement within Medical Lab Technology)
Invalid Input
Other
Invalid Input
Proposed by
Invalid Input
NSCMLT / CSMLS No
Invalid Input
Name of Seconder
Invalid Input

Other Members Endorsing the Nomination

Name  /  Workplace  /  NSCMLT No.

Get in Touch

380 Bedford Highway, Suite 202
Halifax, Nova Scotia B3M 2L4

Email: info@nscmlt.org

Phone: 902-453-9605

Toll Free: 888-897-4095 (NS only)

Fax: 902-454-3535