Buddy Horton Excellence in Treatment Award Nomination Form

Buddy Horton Excellence in Treatment Award 17th Annual Georgia School of Addiction Studies 2024

In recognition of accomplishments to the field of treatment in Georgia, the Georgia School of Addiction Studies will present the Buddy Horton Excellence in Treatment Award for an Organization.
Buddy Horton Excellence in Treatment Award

The award will be presented at the 2024 Georgia School of Addiction Studies, Wednesday afternoon treatment luncheon on August 28, 2024,at Hyatt Regency Hotel in Savannah, Georgia. Nominations may be made by completing this form. Nomination form(s) must be received no later than close of business July 21, 2024.
Nomination Criteria:

Nominee should be active in the addiction treatment field in the state of Georgia. The award will be based on the organization’s accomplishments during the past year and general accomplishments in treatment over their organizational existence. Winner will be notified prior to luncheon and is required to attend to receive the award. The person making this nomination will be asked to co-present the award at the Georgia School on August 28, 2024
Application Instructions/Criteria

Complete the following JotForm by July 21, 2024. No attachments accepted. Deadline is close of business (5pm) July 21, 2024. The person making this nomination will be asked to co-present the award at the Georgia School on August 28, 2024. You will receive a reply/notification upon our receipt of the nomination form.
Buddy Horton Excellence in Treatment Award - Organization Nominee Form

17th Annual Georgia School of Addiction Studies 2024
Reason For Nomination
Explain why your nominee deserves the selected award.

Nominee Information
Nominee's Organization
Nominee's Name

First NameLast Name
Nominee's Work Phone Number

Area CodePhone Number
Nominee's Cell/Home Phone Number

Area CodePhone Number
Nominee's E-mail Address
Nominee's Agency/Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nominee's Home Address (if known)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1) Brief biography/history of the organization.
2) List organization’s Accomplishments/Contributions in the Past Year to the treatment field. (Include a description of the types of treatment activities, the continuity of the activities (i.e. is this a one time activity or ongoing), number of populations reached, materials developed, innovations, outcomes, collaborations, and impact on the community):
3) List of organization’s Other Accomplishments/Contributions over their past five years in the treatment field. (Can include their development and implementation of treatment programs/services, a description of their contributions to treatment advocacy, collaboration, professional development, number of populations reached, and service on boards, committees, or coalitions):
4) A summary statement of why this organization should receive the award.
5) Organization’s approximate length of time in treatment field: _____ years.
6) Is an organization’s representative available on 8/28/2024 to receive this award?

YesNo

Your Information
Your Name

First NameLast Name
Your E-mail Address
Your Phone Number

Area CodePhone Number
Should be Empty:

Buddy Horton Excellence in Treatment Award 17th Annual Georgia School of Addiction Studies 2024

Buddy Horton Excellence in Treatment Award

Nomination Criteria:

Application Instructions/Criteria

Buddy Horton Excellence in Treatment Award - Organization Nominee Form