JEAN DELAY PRIZE
Deadline: February 28, 2011
Nomination Form
The Jean Delay Prize is awarded by an international jury to an individual who has made a major contribution in the
biological, psychological or social aspects of Psychiatry or has built useful bridges between them.
The Prize bears the name of the first President of the WPA, one of the most important psychiatrists of the 20th century.
It consists of a diploma, a medal and a check for the amount of 40,000 Euros. The awardee is expected to deliver a
plenary lecture at the World Congress of Psychiatry.
Nominee:
Family Name: ____________________________________________________________
First Name:
____________________________________________________________
Address:
Institution: ______________________________________________________________________________________
Street: ________________________________________
State/Province: __________________________
Postal Code: ________________________________
Country: _______________________________
Phone: _________________________
Fax : ___________________
Email: _________________________
Nominee’s Strengths as Perceived by the Nominator
Date
Nominator’s signature
Nominator’s name
Date
Nominee’s acceptance signature
Please return completed forms to: WPA Secretariat, Geneva University Psychiatric Hospital,
Batiment Les Voirons, 2, Chemin du Petit Bel-Air, 12225 Chene-Bourg, Geneva, Switzerland. Email: wpasecretariat@wpanet.org
Biographical Summary of the Nominee
Page 2
Please summarize on this page the educational accomplishments, degrees obtained, professional experience, appointments,
publications and innovative activities that support the Nominee’s eligibility to the Jean Delay Prize.
The Jean Delay Prize is supported by an unrestricted grant from Servier