Milwaukee Mental Health Task Force:
2022 Karen Avery Award Nomination Form

The Milwaukee Mental Health Task Force Karen Avery Award annually recognizes an individual whose work and values align with the legacy of Karen Avery, who was a respected leader in the mental health consumer/survivor movement, working to advance the rights of people with mental illness and to ensure a strong consumer voice.

Deadline: All nominations are due by noon on Tuesday, November 1st.

Questions? Contact Barbara Beckert via email at barbara.beckert@drwi.org or Disability Rights Wisconsin via phone at 414-292-2724.

Nominee's Information
Please enter as much information as possible.
1.Nominee's Name (required):(Required.)
2.Nominee's Address (required):(Required.)
3.Nominee's Email (optional):
4.Nominee's Phone Number (optional):
5.Nominee's Agency (optional):
6.Nominee's Role/Job Title (optional):
Nominator's Information
Please enter all information below.
7.Nominator's Name (required):(Required.)
8.Nominator's Address (required):(Required.)
9.Nominator's Email (required):(Required.)
10.Nominator's Phone Number (required):(Required.)
Nomination Narrative
Please complete the following questions.
11.Explain how the nominee has advanced the rights and independence of people with mental illness and/or other disabilities (required).(Required.)
12.Describe the nominee’s work to support and advance the peer movement and/or elevate the voices of peers, or any other factors that reflect the values and legacy of Karen Avery (required).(Required.)
13.Share one story or example that demonstrates why this person reflects the values of the Karen Avery Award (required).(Required.)