NOMINATION FOR THE J.L. MORENO AWARD

The J.L. Moreno Award is presented annually to an individual for outstanding life-long contributions in the field of psychodrama. Selection is based on general achievement over a period of at least 30 years. Please complete the following form in as much detail as possible.

Name of Nominees______________________________________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX ______________________________

E-mail _____________________________________________

In narrative form, on an attached sheet, please state the contributions to the field of psychodrama that make the nominee an outstanding resource. Please remember that this award does not apply to contributions made to the ASGPP specifically, but rather to life-long contributions to the field of psychodrama in general. Include such things as publications, research, presentations, activities within the ASGPP, teaching, applying psychodrama in society, etc. Attach additional sheets if necessary. 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