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2011 Awards Nomination Form

Anyone may make a nomination!

In order to support and recognize outstanding individual achievements in the field of substance abuse treatment, the Alaska Addiction Professionals Association is accepting nominations for the following

Francis J. Phillips Award Presented for many years of outstanding statewide contributions to the addictions field. Presented to an innovative individual who demonstrates commitment to excellence, ethical standards, interagency cooperation, and is an inspiration and leader in the addictions field.

  • Change Maker‖ Award

The ―Change Maker‖ award is an honor bestowed upon an individual in recovery whose very life is an inspiration to others. He/she is not an addictions counselor or professional in the field. Instead, this person serves as a role model in many possible ways. Perhaps he/she has accomplished an educational or vocational goal, volunteers in some capacity in the community, or does an outstanding job in his/her chosen profession. The ―Change Maker‖ is responsible for his/her own recovery and is the kind of person others in recovery aspire to be. He/she has rejoined the mainstream of society and is considered a contributing member in a significant way.

A Release of Information (ROI) form must be signed by the individual being nominated for the ―Change Maker‖ award and attached to the award nomination form. Thank you.

Ernie Turner Award

Presented to a counselor actively working in the field who has made an outstanding contribution to the profession of addictions

counseling

by

demonstrating:

ethical

professional

development,

cultural

standards, ongoing competency, and

interagency collaboration. This person is an inspiration to those he/she serves.

  • Friend of the Field‖ Award

The ―Friend of the Field‖ award recognizes a non-clinical staff member of an organization who provides continual and outstanding service to persons who are in treatment or recovery. Examples of possible candidates for this award may be as varied as a board member of an organization, a maintenance person who prepares a room for AA meetings, a program administrator, a Legislator, a bus driver, or a cook for a treatment program. The recipient of this award is dedicated to making treatment happen for others. He/she is well respected by co-workers and clients and has a proven track record of

outstanding service to their organization.

How to Submit a Nomination Completely fill out the award nomination form and attach a narrative explanation of why you think the person is deserving of the award. A separate ballot and narrative must be completed for each nomination. Nominations must be received by April 10, 2011. Award recipients will be honored at the Annual School awards luncheon on May 4, 2011 and will receive a scholarship for the 2011 Annual School on Addictions. Please contact AAPA at (907) 242-6638 for additional information.

(Please print)

Please indicate to which award your nomination applies:

_____________________________________________

Nominee’s Information N o m i n e e s N a m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N o m i n e e s A f f i l i a t i o n / O r g a n i z a t i o n : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N o m i n e e s M a i l i n g A d d r e s s , C i t y , S t a t e , Z i p : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Nominee’s Phone Number (Day):

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E - m a i l : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Nominator’s Information Nominator’s Name:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N o m i n a t o r s A f f i l i a t i o n / O r g a n i z a t i o n :

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

N o m i n a t o r s M a i l i n g A d d r e s s , C i t y , S t a t e , Z i p : A d d r e s s :

______________________________________________________

Nominator’s Phone Number (Day): ____________________________________________

E-mail:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Attach narrative and mail to SADA address: P.O. Box 92580, Anchorage, AK 99509 A complete call for (fill-in) nominations forms are available on our website at www.sada-ak.org. You can also fax the nomination form to 1-866-252-8824 or e-mail to sada@ak.net

May 2-4, 2011Anchorage Sheraton Hotel

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