FSAS 2008
PROFESSIONAL OF THE YEAR
Nomination Form
ELIGIBILITY CRITERIA:
· A person who has worked in the addictions field for a minimum of five (5) years.
· For the professionals who provide direct services to consumers and who have consistently contributed to the field of addictions, distinguished themselves beyond the requirements of their jobs, and demonstrated excellence in the field.
· Must be available to attend the 2008 School July 20 through July 24, 2008.
NOTE: Current/former members of the FSAS Board of Directors are not eligible for this award.
PLEASE PRINT
ALL INFORMATION MUST BE LEGIBLE
Nominee’s Information:
Name:________________________________________________________________________
Address:________________________________City:________________State:___Zip:________
Home Phone: ( )______________E-mail address:___________________________________
Degrees, licenses, certifications and dates received:__________________________________________________________________________
Employer:_________________________________________________________________________
Employers’ address:_________________________________________________________________
City State Zip
Supervisor’s name:_______________________Supervisor’s’Phone:(____)_____________________
E-mail address:___________________________________________________________
Job Title _______________________________________
Nominator’s Information:
Name:________________________________________________________________________________
Address:___________________________________City:_________________State:____Zip:__________
Home Phone: ( )_________________ E-mail address:_____________________________________
Nominator’s
Signature:___________________________________________
Nominator will furnish nomination letter that will include your reasons for nominating this person for Professional of the Year and include examples of accomplishments that advance the field of substance abuse treatment or prevention, the major contributions above and beyond his/her regular job requirements, exemplary work accomplished during the past year, recognition or awards received to date, and other relevant information concerning achievements or qualifications.
Mail nomination form, nomination letter, resume, and 2 letters of recommendation from other individuals to:
Florida School of Addictions Studies, Scholarship Chairperson
1725 Art Museum Drive
Jacksonville, FL 32207
REGISTRATION INFORMATION CONTACT:
Telephone: 1-888-933-FSAS
E-mail: fsas@nefsc.org
Web Site: www.fsas.org
DEADLINE: Nomination, nominator’s letter, resume & 2 letters of recommendation must be received no later than the close of business on Tuesday, November 6, 2007. |
