Laurie Sugarman-Whittier 2023 Wellness Award Nomination Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Southborough Youth and Family Services (SYFS) will be awarding the Laurie Sugarman-Whittier Wellness Award in May for Mental Health Awareness Month to honor an individual in one or more of these areas:

· Someone that has promoted the mission of making Southborough a better place for all

· A person who is a mental health or human services advocate

· An individual that embodies wellness and resilience after overcoming challenges and adversity

· Or someone that has worked in some other capacity to promote human welfare in Southborough.

There is no age requirement for this award and the award is not limited to Southborough residents though nominees must serve the Southborough community in some capacity.

SYFS is asking for nominations for this award from members of the Southborough community. If you know someone who has promoted community wellness or human services excellence, SYFS is open to nominations until Friday, March 31, 2023

Your name *

Your email *

Your phone number *

Your connection to Southborough (i.e. resident, employee, etc.) *

Nominee's name *

Nominee's phone number *

Nominee's email *

A mailing address that will reach your nominee *

Your nominee's connection to Southborough (i.e. resident, employee etc.) *

Please check off all of the qualities that you feel apply to your nominee. *

This is someone that has promoted the mission of making Southborough a better place for all.

This is a person who is a mental health or human services advocate.

This is an individual that embodies wellness and resilience after overcoming their own challenges and adversity and has used that to help others.

This is someone that has worked in some other capacity to promote human welfare in Southborough.

Required

Please explain why you feel your nominee is deserving of this award. Please be thoughtful in your response as this section is shared with the Youth Commission who will be choosing this year's award recipient. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms