NOMINATION FOR THE HANNAH WEINER AWARD

The Hannah Weiner Award is presented annually to an individual for outstanding dedication to the American Society of Group Psychotherapy and Psychodrama. Please complete the following form in as much detail as possible.

Name of Nominee______________________________________________________________

Address_______________________________________________________________________

City____________________________ State____________ Zip_______________

Phone ______________________________________ FAX ______________________________

E-mail _______________________________________________

In narrative form on a separate page, please state the contributions to the ASGPP that make the nominee an outstanding resource. Please remember that this award does not apply to the field of psychodrama in general, but specifically to contributions made to the ASGPP. Include such things as volunteer services, committee work, offices held, 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