CVSA International Safety Team Awards Program

2013 CVSA International Safety Team Application

 

	Nominator's Name:
	Nominator's Email:
	Nominee:
	Nominee Agency Name:
	Nominee (work) Address:
	City
	State/Province:
	Zip/Postal Code:
	Phone Number:	- - ext.
	FAX:	- -
	E-mail address:
	CVSA Region:	Select Region Region I Region II Region III Region IV Region V
	Describe the Nominee's outstanding contributions aimed at improving CMV safety.  Demonstrate the effectiveness of the Nominee’s contribution(s).  Not to exceed four pages of double-spaced print may be submitted as the application.  Supporting documentation may be submitted but is limited to one, 1” three ring binder.

 

Region I:
Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, US Virgin Islands, and Vermont.

Region II:
Alabama, American Samoa, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

Region III:
Colorado, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska,
North Dakota, Northern Mariana Islands, Ohio, South Dakota, and Wisconsin.

Region IV:
Alaska, Arizona, California, Guam, Hawaii, Idaho, Mexico, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

Region V:
Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Northwest Territories, Nunavut, Ontario, Prince Edward Island, Quebec, Saskatchewan, and Yukon.