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2. Submission Deadline

   October 13, 2023

3. Presentation of Award

   PLT Annual Meeting on October 25, 2023

5. Guidelines for Submitting a Nomination
   Completion of this nomination form
9. Who are you?
   We would like to know who is making a nomination for this award.
11. Submitted By*
12. Date of Submission*
    Date of Submission
14. Email Address*
18. Who are you nominating?
    Tell us about your nominee.
20. Name*
21. Email Address*
23. Nomination Category*

    1. Teen
    2. Adult
    3. Organization/Business
    4. Community
25. List examples of the nominee’s contribution to youth related prevention work *
    500 character limit
27. Describe the nominee’s impact on the community or organization *
    500 character limit
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field