Nomination Form

The Virginia Mental Health Access Program (VMAP) is a statewide initiative that helps health care providers take better care of children and adolescents with mental health conditions through provider education and increasing access to child psychiatrists, psychologists, social workers, and care navigators. We are committed to integrating behavioral health equity into our program, training, and outreach efforts to ensure all providers across the state and the youth/adolescents they serve can benefit from VMAP.
 
The purpose of this nomination is to give the VMAP Executive Committee a better sense of who the applicant is, the applicant's expertise in diversity, equity, and inclusion (DEI), and what added benefits (both personal and professional) the applicant brings to VMAP. There is no limit to the number of applicants an individual/organization can nominate.
 
Applicants can be nominated by:
  1. A colleague familiar with your work (supervisor, advocacy organization, members of other groups you are affiliated with, Hospital CEO, Free Clinic Medical or Executive Director, Agency supervisor, etc.).
  2. Self-nomination
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