Nomination Form

The criteria are simple. Tell us about someone, in at least 500 words, who best personifies the awards descriptions.

Please give consideration to:

• Length of service

• Scope and impact of work

• Degree of difficulty and obstacles encountered

• Imagination and innovation

The nominees will be voted on and selected by the Symposium Program Committee. Recipients will be honored for their accomplishments at the Symposium. Scholarship recipients receive educational monies for college tuition.

2019 Black Mental Health Symposium Nomination Form

Simply fill in the information above and send it, along with your nomination to: LifeSkills Counseling & Consulting Group. Email: latonya.summers@lifeskillsccgroup.com.

www.lifeskillsccgroup.com

Due by March 31st 2019.