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NOMINATION FORM for 2020 Mental Health Champions' Award

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NOMINATION FORM

2020 Mental Health Champions' Award

The Missouri Mental Health Champions' Award recognizes individuals living with a mental illness, developmental disability, or in recovery for substance use disorders, who make a positive contribution to their community, exemplify commitment and vision, and whose actions have increased the potential for independence in others living with a mental health condition.

Annually, three individuals are selected to receive the Mental Health Champions' Award. The award recipients are chosen from nominations received from across the State of Missouri. One champion is selected from each of the three nomination categories: mental illness, developmental disabilities, and substance use disorders. The award recipients will be celebrated at the annual Mental Health Champions' Banquet, scheduled for Tuesday, June 23, 2020 at the Capitol Plaza Hotel in Jefferson City.

If you have any questions regarding the Mental Health Champions, please contact the Missouri Mental Health Foundation at (573) 635-9201 or mmhf@missourimhf.org

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CATEGORIES

Persons may be nominated in one of three categories:

1. An individual with a diagnosed mental illness

2. An individual with a developmental disability

3. An individual in recovery from a substance or gambling addiction

NOMINATION APPLICATION

* Nominees must agree to allow their stories to be told

* Those who nominate eventual winners may be asked to appear in a video tribute to that individual, along with others who have witnessed or who may benefit from the winner's noted accomplishments.

SUBMISSION DEADLINE: Wednesday, December 5, 2019

If you prefer, nominations may be faxed to (573) 469-7268 or mailed to: MMHF, 221 Metro Drive, Suite C, Jefferson City, MO 65109

ALL NOMINEES MUST SIGN A RELEASE FORM GRANTING THE MISSOURI MENTAL HEALTH FOUNDATION UNLIMITED PERMISSION TO USE, FILM AND PUBLISH THEIR LIKENESSES AS WELL AS INFORMATION ABOUT THEM.

Please do NOT send videos, scrapbooks, or binders. They will not be considered and cannot be returned.

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