2023 PA Peer Partner Nomination Form

Do you know someone who has made significant contributions to the advancement of peer services in Pennsylvania?

Nominate them to be chosen as the 2023 PA Lifetime Peer Partner Award recipient by completing the form below.

A selection committee will review all nominations received by May 12, 2023 and choose one individual to be recognized at the 2023 Banquet taking place on June 16.

2023 PA Lifetime Peer Partner Award Nomination Form

This form is to be used to nominate an individual for the 2023 PA Lifetime Peer Partner Award that will be handed out at the Banquet taking place on June 16. This award was created to honor and recognize an individual who has significantly impacted peer services in Pennsylvania. Nominees do not necessarily have to be certified peer professionals, just someone who has contributed to the advancement of peer services in Pennsylvania.

Your Name(Required)

First Last

Name of person submitting this form.

Your Email(Required)

Email of person submitting this form

Your Phone

Phone number of person submitting this form

May the selection committee contact you to gather more information about your nominee?

Yes

Nominee(Required)

First Last

Name of person you are nominating for the 2023 Lifetime Peer Partner Award.

Nominee Contact Info (email, address, phone, etc.)(Required)

Please provide as much contact info as possible for the individual you are nominating (at least an email). Nominations the are received without contact information may be removed from consideration.

Why are you nominating this individual?(Required)

Please be specific. What are the nominees accomplishments in the peer field? Why do they deserve this recognition? The more detail you can give the better.