RECOMMENDATION FOR AWARD

MCA FORM 701

AUTHORITY: Michigan Public Health Code, Part 209; Muskegon County Medical Control Authority Bylaws; and the Call to Honor Awards Program, as adopted by the MCMCA Board.

PURPOSE: To consider individual or team nominations for recognition under the Call to Honor Awards Program; record final action; and maintain a permanent record of award recipients.

ROUTINE USES: Information provided may be used for award verification, publication of award recipients, or internal quality assurance review by the Awards Committee. Limited identifying information may be shared with affiliated agencies of the media for the purpose of recognizing honorees.

DISCLOSURE: Submission of personally identifiable information is voluntary; however, incomplete information may delay or prevent processing of the nomination.

PART I - NOMINEE INFORMATION

Instructions: Enter the nominee's full name, agency, license level, and any previous awards. This information identifies the individual or team being nominated. Please verify spelling and agency name exactly as it should. If the award is to nominate an agency, please include the agency operations director or equivalent as the nominee.

PART II - RECOMMENDER INFORMATION

Instructions: Provide your contact details so the Awards Committee may verify or clarify the nomination. Include your rank or position, organization, and a valid email address.

PART III - RECOMMENDED AWARD (CHOOSE ONLY ONE)

Instructions: Select the award category that best fits the nominee's achievement. Review award descriptions on the Call to Honor website before choosing. Only one category may be selected per submission.

The Awards Committee will review all nominations for accuracy, completeness, and appropriate classification. The committee reserves the authority to approve, downgrade, upgrade, or disapprove any recommendation submitted. Recommendations may be reassigned to a more appropriate award level or declided if they do not meet established criteria. This process ensures fairness, consistency, and the integrity of the Call to Honor Awards Program.

Individual Medals for Valor

Individual Medals for Merit

Civilian and Allied Force Medals

Annual Provider and Agency Awards

Incident Specific Recognitions

PART IV - JUSTIFICATION

Instructions: Please provide a detailed description of the incident, actions, and outcomes that justify the nomination. Include specific dates, events, and measurable impacts. Attach any supporting documentation (e.g., patient care reports, dispatch logs, witness statements, media coverage).

Use Clear, factual language. Avoid abbreviations unless commonly understood in EMS.

PART V - PROPOSED CITATION

Instructions: Provide a clear, concise, and dignified summary of the nominee's actions or service that led to this award. The proposed citation should be written in formal language suitable for inclusion on the official award certificate and for public reading during the ceremony.

The citation should typically consist of one to three sentences, beginning with a phrase such as "For distinguished service..." or "For demonstrating exceptional courage and dedication..." Avoid excessive detail or technical language; focus on the essence of the achievement, its impact, and the values it represents.

The Awards Committee reserves the right to edit or refine the citation to ensure consistency, accuracy, and appropriateness for formal presentation.

PART VI - SUPPORTING DOCUMENTS

Instructions: Check all documents types included and upload relevant files. Supporting documentation strengthens the nomination and may include reports, statements, or media verifying the nominee's actions.

PART VII - NOMINATION CERTIFICATION

By signing below, I certify that the information provided is accurate and truthful to the best of my knowledge, I understand that the Call to Honor Awards Committee may verify the details submitted and adjust the nomination as needed to ensure fairness and consistency in award distribution.