N.26 MEDIC First Aid Distinguished Instructor Nomination Form

/ GOLD WING ROAD RIDERS ASSOCIATION, INC. /
RIDER EDUCATION PROGRAM
MFA DISTINGUISHED INSTRUCTOR NOMINATION FORM
Date of Nomination / /

In order to be considered for recognition as, and promotion to, MEDIC First Aid Distinguished Instructor the nominee must meet the following criteria. The officer nominating the MEDIC First Aid Instructor must check off and validate the following:

That the nominated Instructor is, or has demonstrated:

Member oriented with a minimum of disgruntled members or member complaints.

Considered well ABOVE AVERAGE within current position.

Good communications skills.

Current Level III in the GWRRA Rider Education Program.

Role model for others in the same office.

Willingly and proactively assists the Educator or MEDIC First Aid Coordinator whenever needed or requested.

Willing and able to provide coaching and mentoring skills to other Instructors in their peer group.

Positive attitude and is pro-active and supportive in administration of the Rider Education Program and GWRRA.

Successful in maintaining participation and growth within the Rider Education Program and sets and achieves goals established for their current position including growth of Level IV participants.

I would like to nominate / for promotion to / MEDIC First Aid Distinguished Instructor
Chapter / District / Region / A - SoutheastB - NortheastD -Great LakesE - America's HeartlandF - SouthwestH - South CentralI - Big SkyJ - Great NorthwestK - Central CanadaL - Canadian AtlanticN - AppalachianV - VikingUK - United Kingdom

Appointed to current office on / /

Appropriate Officers’ Signatures: (See requirements on nomination form)
Nominating Director: / Signature / District DirectorAssistant District DirectorDistrict EducatorAssistant District EducatorRegion DirectorRegion EducatorAsst. Region EducatorNational Director Rider EdAsst. National Director Rider EdInternational Director Rider EdAsst. Intl. Director Rider Ed
Position / /
Date

Concurring Officers: I agree with the above nomination and approve the promotion.

(Chapter level promotions must be approved by District Officers, District by Region Officers, Region by National Officers)

District Educator / Signature / Date / /
District MFA Coordinator / Signature / Date / /
Region Educator / Signature / Date / /
Region MFA Coordinator / Signature / Date / /
IDRE/NDRE / Signature / Date / /
Please mail the completed form to obtain the certificate to:
Lydia Bourg
935 Eldridge Road #355
Sugar Land, Texas 77478
Office use only: International Rider Ed Staff: ______

Revised March 2017