Young Innovators in Behavioral Health Nomination Form
We are pleased to announce the Young Innovators in Behavioral Health Awards program, recognizing young leaders who have made significant contributions to the field of mental health access, awareness and advancement. 

Awardees will be receive an all expenses paid trip to the Behavioral Health Tech conference in Phoenix, AZ on November 15th to receive a cash prize and be recognized on stage in front of hundreds of healthcare executives, digital health leaders, investors and foundations, policymakers and more. Awardees will also be recognized on behavioralhealthtech.com and our media partners. 

Individuals and Organizations can nominate a young leader (self-nominations are acceptable) by filling out the form below.

Award Candidates must be between the ages of 18-29 and based in the United States. See our FAQs here for more information.

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First and Last Name of Nominator if different from Award Candidate:
Email of Nominator if different from Award Candidate:
For the next set of questions, please add the Award Candidate's information, not the Nominator's information:
First Name *
Last Name *
Title *
Organization Name *
Email *
Birth Date *
MM
/
DD
/
YYYY
Pronouns *
Race *
Ethnicity *
Website *
Please provide a brief description of the Award Candidate's work in mental health: *
Why should this Award Candidate be nominated for the Young Innovators in Behavioral Health Awards program? *
Phone Number *
LinkedIn Profile:
Twitter Profile:
Instagram Profile:
Other website/social media:
Which category is the award candidate best defined by? *
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