Jim Edmundson Lifetime Achievement Award Nomination


Nominations/Submissions may be for ANYONE distinguishing themselves in the field of SUBSTANCE MISUSE in the State of North Carolina. For information about the award, please visit the Jim Edmundson Lifetime Achievement Award page.


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Nominator's Name (Required):

Email (Required)

Physical Address:

Phone:

Summary of the Reason(s) Why You've Decided to Nominate the Nominee for This Award (50 Words or Less):





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Nominee's Name (Required):

Nominee's Email (Required)

Nominee's Physical Address:

Nominee's Phone:





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List of Nominee's Significant Achievements:

List of Nominee's Involvement in Substance Misuse (Prevention/Treatment/Advocacy/Awareness/Misc...) Activities:

List of names, addresses & phone numbers of (3) THREE references who could attest to the above information:

Additional Comments: