Nomination closes: Friday, September 6, 2019

Nominee must be an individual in the professional role as a peer who has gone above and beyond in the community to make positive change in the lives of others in the community with a mental health and/or substance use disorder.  An individual who is active in leadership committees who continues to advocate for others impacted by mental health and/or substance use disorders.

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* 1. Name of Individual making the nomination.

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* 2. Your phone number or email address.

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* 3. Nominee's Name.

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* 4. Nominee's Role in the Community.

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* 5. Nominee's phone number or email address.

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* 6. Is the nominee aware of your nomination?

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* 7. Please describe (in detail) why this individual is deserving of this award.
Provide achievements, impacts on our community and other highlights.

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