Nomination Form - Black Mental Health Symposium

The Black Mental Health Symposium seeks to honor the extraordinary people working to improve mental health among Black communities. In alignment with our 10th-anniversary theme—Remember. Reset. Reclaim.—we are now accepting nominations for our annual scholarships and awards. We invite you to nominate yourself or a colleague who embodies the mission.

NOMINATOR INFORMATION

Details of the person submiting the nomination.

Nominator name

AWARD SELECTION

Please select the award for which you are making a nomination.

Ethel L. Wallace Scholarship

A master's or doctoral student in a mental health profession working to improve Black mental wellness.

Distinguished Practitioner of the Year

A Black private practitioner who works to improve Black mental health in the community.

Distinguished Mental Health Advocate of the Year

A Black advocate who works outside the mental health profession to improve Black mental wellness

Black improve email

Black Mental Health Educator of the Year

A Black faculty member who works to improve Black mental wellness through education and training.

NOMINEE INFORMATION

Details about the person being nominated.

Nominee email

Nominated Person

Please provide rationale for your nomination. Tell us about your nominee and the work they've done to improve Black mental wellness.

Apply to present

Exhibitors

Nominations

NOMINATOR INFORMATION

AWARD SELECTION

NOMINEE INFORMATION

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