Milwaukee Mental Health Task Force:
2022 Marie C. Perry Rising Leader Award Nomination Form

The Marie C. Perry Rising Leader Award is inspired by the dedication of our inaugural recipient, Marie C. Perry. The award honors Marie's memory and recognizes visionary leadership by an individual who is a rising and/or young leader in the Milwaukee area mental health community. The recipient receives an $800 scholarship for continuing education.
 
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 demonstrated outstanding leadership to advance mental health and recovery values in our community. This may include one or more of the following: visionary leadership, providing outstanding service, effective advocacy, teaching and mentoring, and/or an ability to inspire others to excel in this work (required).(Required.)
12.Tell us why the nominee is a positive role model for others (required).(Required.)
13.Share one story or example that demonstrates this person’s impact as a rising leader in the Milwaukee mental health community (required).(Required.)