Barbara Herbert Award Nomination Form
This award honors the legacy of MASAM past president BarbaraHerbert, MD, a tireless advocate for equitable addiction careand for the rights of marginalized communities.We seek nominations of MASAM members who demonstrateleadership in advancing equity, improving access to high-quality addictiontreatment, strengthening systems of care, and addressing the socialdeterminants of addiction.
Nominator Information
Your Full Name
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First Name
Last Name
Your Email Address
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example@example.com
Your Institution/Organization
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Your Relationship to the Nominee
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Nominee Information
Nominee Full Name
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First Name
Last Name
Nominee Title/Role
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Nominee Organization
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Nominee Email Address (optional)
example@example.com
Is the nominee a MASAM member?
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Yes
No
Unsure
Nomination Statement
Equity, Inclusion & Structural Impact
: Recognizes efforts that advance equity and inclusion, and address structural barriers in addiction medicine.
Access & Quality of Care
: Honors initiatives that improve access to high-quality addiction care for diverse populations.
Nomination Statement (max 300 words)
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Supporting Materials
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Upload Letter of Support (optional)
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Certification
I confirm that the information provided in this nomination is accurate to the best of my knowledge.
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I agree
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