The CCS Board of Managers has established this self-administering awards program to recognize Medical Personnel (Team Doctors, Physical Therapists, Trainers, EMTs, etc) who have served a particular CCS High School for a designated number of years.

This program provides for those medical personnel, whose names are submitted by any CCS member school, to receive a lapel pin designating 5, 10 or 20 years of Medical Service to that school.  In the Fall, each CCS Principal will receive this copy of the Medical Service Award form, for their use in submitting any appropriate names.  When the forms are received by CCS, the pin(s) will be mailed out as requested by the school.

We are hopeful that this will provide an additional opportunity for schools to say THANKS to those medical personnel who have supported their student-athletes.

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MEDICAL SERVICE AWARD

Medical Person to be honored:___________________________________________

Honorees Title (e.g. Dr. Trainer, etc.)_______________________________

# of Years Served:___________

School/League served:______________________________________________

Please provide complete address of where you would like the pin sent. Pins sent directly
to the Honoree from the CCS include a letter congratulations.  Schools wishing to present
the pin to the Honoree in person or at a special awards ceremony, should request the pin
be sent to the school for such presentation.

Pin should be sent to:_________________________________________________
(name & address)

Forms submitted by:________________________________________________
                                (please print name)                             (Title)

Please submit this form to CCS, 6830 Via Del Oro, Suite 103,  San Jose CA 95119