2019 Gerstein Award Nomination Form

2019 Joseph Gerstein Award Nomination Form

A candidate for this award will have remarkable attributes such as: long and continued service to SMART; significant contributions of time and funds; adding significantly to the science and evidence-base foundation that supports SMART’s concepts and tools; championing significant new initiatives; working energetically and creatively to support SMART’s activities, etc.

Instructions:

1. Nominations for the Joseph Gerstein Award is open to the SMART Recovery community at large (online, face-to-face, behind the scenes, committee members, international,etc.)

2. You may not nominate yourself for an award.

3. The Award will be announced in September 2019 at the SMART Recovery Annual Conference.

4. A cash value of $1000 is associated with the award, to be used by the recipient to further SMART Recovery.

5. Please complete all information on this form.

6. DEADLINE for submission of nominations is August 1, 2019.

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* 1. Your name (the person submitting the nomination):

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* 2. Your affiliation with SMART:

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* 3. Your Phone Number

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* 4. Your email address:

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* 5. NOMINEE’S name:

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* 6. Nominee's Affiliation(s) with SMART: (e.g. Message Board volunteer, member of XYZ Committee, Facilitator, etc.):

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* 7. Nominee's Secondary Affiliation (optional—employer / professional credentials):

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* 8. Nominee's Phone Number:

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* 9. Nominee's Email Address:

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* 10. How long has the NOMINEE been involved with SMART Recovery?

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* 11. Statement of why your NOMINEE should be selected to win the 2019 Joseph Gerstein Award:

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* 12. Additional information, if any:

Thank you for nominating your candidate for the 2019 Joseph Gerstein Award!