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Nomination Form

The Judge Stephen S. Goss Memorial Award recognizes at least one judge and one psychiatrist each year who have demonstrated extraordinary leadership in improving the lives of people with behavioral health needs who are involved in the criminal justice system. Complete this form to nominate someone you believe exemplifies great leadership in this area, whether for a lifetime achievement award or as someone who is currently using their career to meaningfully impact the behavioral health and criminal justice systems through their person-centered and thoughtful work with individuals.

A selection committee will review each nomination and determine eligibility based on the impact of their work, including both their use of research-backed strategies and their innovative spirit. In keeping with the Judges and Psychiatrists Leadership Initiative (JPLI)’s commitment to justice and health for all, a demonstrated commitment to reducing disparities will be among the selection criteria.

Winners will be selected based on the strength of their nomination application and their accomplishments, so we encourage nominators to detail their reasons for nominating the person. We look forward to learning more about all the nominees!

Please submit nominations by October 24, 2025. Winners will be presented with their award during a virtual awards ceremony in early December 2025.

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* 1. Name of the person being nominated:

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* 2. This person is a:

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* 3. Are you nominating this person to be considered for a lifetime achievement award?

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* 4. What is the nominee’s position/role?

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* 5. Your name and role:

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* 6. What is your relationship to the nominee?

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* 7. Your contact information:

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* 8. Nominee’s contact information:

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* 9. Tell us why you believe your nominee should receive a leadership award for improving outcomes for people involved in the criminal justice system who have behavioral health needs. You will have an opportunity to upload any relevant files in a following question. Please limit your response to 500 words.

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* 10. Please list 3 ways your nominee has impacted the lives of people with behavioral health needs and helped to reduce their cycle into and overrepresentation in the criminal justice system.

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* 11. (Optional) Feel free to attach any written materials, videos, etc. that will help us understand the impact of your nominee’s work to supplement your written response above.

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* 12. In keeping with the JPLI’s commitment to justice and health for all, a demonstrated commitment to reducing disparities will be among the selection criteria. Tell us about how your nominee has demonstrated a commitment to reducing disparities in the justice and/or health systems. Please limit your response to 500 words.

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