NOMINATION FOR ZERKA T. MORENO AWARD
The Zerka T. Moreno Award is given annually to an individual who is not a TEP or a Fellow of the Society for distinguished work in psychodrama, sociometry and group psychotherapy.
Selection is based on accomplishments in the following categories:
publications
professional presentations
research
professional activities leading to the increasing utilization and awareness of psychodrama
ASGPP membership activities.
Please complete the following form in as much detail as possible:
Name of nominee_______________________________________________________________
Address _______________________________________________________________________
City____________________________ State____________ Zip_______________
Phone ______________________________________ FAX ___________________________
E-mail ______________________________________________
Professional Publications
Presentations made to professional associations. Include organization name, date, and title or presentation
Recent research activities
ZERKA T. MORENO AWARD page 2
Professional activities leading to the increased utilization and awareness of psychodrama, sociometry and group psychotherapy.
ASGPP membership activities. Include such things as committee work, volunteer work at annual meeting, activity in local chapters.
Is the nominee a certified practitioner? ____Yes ____ No
From whom has the nominee received psychodrama training?
Additional comments
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