NOMINATION FOR THE DAVID A. KIPPER SCHOLARS AWARD

The David A. Kipper Scholars Award for writers and researchers is presented annually, when an appropriate candidate exists, to that member of the American Society of Group Psychotherapy and Psychodrama whose writing and/or research has made a significant contribution to the understanding and practice of psychodrama, sociometry, or group psychotherapy. Please complete the following form in as much detail as possible.

Name of Nominee______________________________________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX ______________________________

Email _____________________________________________

In narrative form on a separate sheet, please state how the nominee’s writing and/or research has made a significant contribution to the understanding and practice of psychodrama, sociometry, or group psychotherapy. 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