Middlesex County Substance Abuse Action Council

MCSAAC 2014 Award Nomination Form

MCSAAC ANNUAL AWARDS NOMINATION FORM

Every year the Middlesex County Substance Abuse Action Council recognizes community members and groups who have contributed to substance abuse prevention in a significant manner. You will find a description of each award below. Attached is one copy of the nomination form. Please feel free to copy the form and nominate as many individuals or groups as you like.

Please e-mail betsey@mcsaac.org for an application. Return nominations via email to betsey@mcsaac.org, or fax them to (860) 346-1043, or send by mail to MCSAAC, 393 Main St., Middletown, CT 06457. THE DEADLINE IS Wednseday, SEPTEMBER 10, 2014.

2014 Prevention Program Award

This award will highlight an outstanding local prevention initiative at the town, school, or regional level. We seek to honor both innovative programs and those that have become “institutions” in their communities. Initiatives may affect a large number of people (e.g., the general population, an entire school) or a smaller number of people in a more intensive, participatory way.

2014 Terry Concannon Award

This award is for an elected official such as mayor, selectman, or legislator, who has made strides in reducing substance abuse and/or contributed to community wellness by promoting prevention initiatives.

2014 Father Michael O’Hara Volunteer Award

This award is for an outstanding individual whose volunteer work at the local level has contributed to reducing substance abuse through prevention initiatives in his or her community.

2014 The Harry Eben Burr Business Award for Prevention Awareness

This award is for a member of the Middlesex County business community (either business or individual) who has gone “above and beyond” to implement, promote or support substance abuse prevention and/or recovery efforts.

2014 Youth Volunteer Award

This award is for an outstanding young person (or youth group) whose volunteer work has contributed to reducing substance abuse through prevention initiatives in his or her school and community.

MCSAAC ANNUAL AWARDS NOMINATION FORM

(please reproduce as needed)

I would like to nominate

_______________________________________________________________________

for the

______Prevention Program Award

______Terry Concannon Award

______Father Michael O’ Hara Volunteer Award

______Harry Eben Burr Business Award for Prevention Awareness

______Youth Volunteer Award

for the following reasons:

 

 

Name_________________________________________ Signature_____________________________

Your organization (if applicable):_____________________________________________

Nominations must be received by September 10, 2014. Fax applications to MCSAAC at (860) 346-1043, email to betsey@mcsaac.org or mail to MCSAAC, 393 Main St., Middletown, CT 06457.

393 Main Street, 2nd floor Middletown, CT 06457