4th Annual Leadership Award of Excellence

2018 Nomination Form

This award recognizes one industry leader - a partner, vendor, consultant, or provider - who demonstrates ongoing commitment and support of EAP and workplace health. The nominee must be from the US when the Institute is in the US and from Canada when the Institute is in Canada.

Requirements:

·  Nominations are due Friday, March 2, 2018. The winners will be notified by Monday, March 12, 2018.

·  The winner will deliver a 10-minute presentation on their EAP program on May 10 or 11 at the 2018 Institute in Vancouver, British Columbia, Canada.

·  All winners must attend the 2018 Institute from May 9-11, 2018 at the Pinnacle Hotel Harbourfront in Vancouver, British Columbia.

Winners will be recognized in EASNA and industry communications.

This is an electronic form, so simply click in a gray box and begin typing. The form fields will expand to accommodate any amount of information. Please complete the form and return by email to EASNA Headquarters. Do not convert the completed form to a PDF file. Handwritten forms and additional documents may NOT be submitted.

Email this completed form to . If you do not receive a confirmation email upon submission, call 703-370-7435 to confirm that we received your form.

Return this Form by Friday, March 2, 2018.

Nominator’s Information

Organization Name (If internal EAP)
EAP Provider
Contact Name
Title
Street Address
City, Province/State, and Postal/ZIP Code
Country
Daytime Telephone
Fax
Email

Nominee’s Information

Leadership Nominee Name
Title
Organization
Street Address
City, Province/State, and Postal/ZIP Code
Country
Daytime Telephone
Fax
Email
1.  How has the nominee demonstrated their ongoing commitment to EAP and healthy workplaces? Limit your answer to 200 words.
2.  How has the nominee contributed to the ongoing vitality and sustainability of the EAP industry? Limit your answer to 200 words.
3.  What has nominee done in the workplace to support our 2018 theme: Your Strategic Partner in Times of Disruption? Please limit your answer to 200 words.
4.  How has the nominee demonstrated creativity and industry leading innovation in wellness, prevention and EAP? Limit your answer to 200 words.
5.  What impact has the nominee had on the quality and outcomes achieved in EAP? Limit your answer to 200 words.

Email this completed form to by Friday, March 2, 2018.

For questions, please call 703-370-7435.

3337 Duke St. · Alexandria, VA · 22314 · Ph: (703) 370-7435 · Fax: (703) 342-4311 · www.easna.org

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