NOMINATION FOR COLLABORATORS AWARD

The Collaborators Award is presented annually, when appropriate, to members of The American Society of Group Psychotherapy and Psychodrama either in pairs or in teams, whose work over time has made a contribution to the learning and practice of psychodrama, sociometry, and/or group psychotherapy, and whose modeling of collaborative roles deserves to be brought to the attention of their peers. Please complete the following form in as much detail as possible. (Please indicate the names of all team members when appropriate).

Name of Nominees______________________________________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX ______________________________

E-mail _____________________________________________

In narrative form on a separate sheet, state how the nominees’ work over time has made a contribution to the learning and practice of psychodrama, sociometry and/or group psychotherapy, and whose modeling of collaborative roles deserves to be brought to the attention of their peers. Please sign your statement and list your address.

Signature of Nominator (may be self-nomination) ______________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX _______________________

E-mail address__________________________________________

Nominations must be postmarked no later than:

August 1

Please mail this form to the national office:

American Society of Group Psychotherapy and Psychodrama

301 N. Harrison Street Suite 508 Princeton, NJ 08540