Recognizing Exceptional People Nomination Form 2025 Survey

1.Your Contact Information(Required.)

First & Last Name

Company/Agency

Your Position/Title

Email Address

Phone Number

2.First & last name of the person you are nominating (or the name of the Organization)(Required.)

3.Choose (1) Award that you are nominating this person/group/organization for per the list below.(Required.)

Max Graves Award - For Outstanding Contributions to Mental Health in Clark County

Richard Wehler Award - For outstanding Contributions to Alcohol & Drug Services in Clark County

Carol Wichman Award - For outstanding Contributions to Mental Health In Greene County

Charles Christopher Award - For outstanding Contributions to Alcohol & Drug Services in Greene County

Jon "Charlie" Alder Award - For Outstanding Contributions to Mental Health, Alcohol & Drug Services in Madison County

Person of The Year Award - For Outstanding Contributions Toward Treatment, Prevention and Recovery Supports

Youth Leader Award - A youth 21 & Under with Outstanding Contributions Toward Mental Health & Drug Services for Youth

Champion of Diversity Award - A person, group, or organization who demonstrates leadership in the work to improve diversity, equity and inclusion in the mental health and recovery fields across treatment, prevention and support.

Delvin M. Harshaw Advocate of The Year Award - For Outstanding Contributions Toward Advocacy in the Community

Beth Dixon Advocate of Youth Award - For Outstanding Contributions to Youth-Led Prevention Advocacy

4.Job Title & Position description of person nominated(Required.)

5.How long have they been in this position(Required.)

6.E-mail address of the person you are nominating(Required.)

7.Why are you nominating this person/group/organization?(Required.)

8.Please upload a photo of your nominee. (If a photo is not available, please be prepared to provide one at a later date.)

Photos may be PNG, JPG or JPEG

No file chosen

Deadline: Nominations are due by 12:00pm Tuesday, January 21, 2025

*Note – Please reserve the date and time below. Be prepared to attend with your nominee should they be selected. A registration link will be provided once the winners have been selected.

Event: Recognizing Exceptional People Award Ceremony
Date: Wednesday February 5, 2025
Time: 5:00 PM - 8:00 PM
Location: Courtyard by Marriott Springfield, 100 South Fountain Avenue, Springfield, Ohio 45502