Stork Award Form
The South Central Minnesota Regional System takes great pride in acknowledging responders who have participated in the delivery of a newborn in the pre-hospital setting. Below you’ll find guidelines for submitting nominations for the South Central Minnesota Stork Award:
1. Nominees must have assisted in the delivery of a newborn in the field.
2. Nominations must be submitted by an agency director
3. For agencies under Dr. Wilcox’s medical direction, an ICR number (run number) is required
4. Awards may be given to personnel from multiple agencies for the same event.
- In the event of multi-agency nominations for a single event, only 1 agency director is required to complete the nomination process.
5. In the event of multi-agency nominations/awards, the nominating agency director must
contact the other agencies involved in the call when making arrangements for any presentation of awards.
Please feel free to contact Mark Griffith at 507-257- 3224 with any questions.
If the above criteria is met, then we encourage you to fill out the form below!
