Please submit by: May 15, 2015
For more information, visit — www.FatherMartinsAshley.org/Award
Name of Nominee:
Title:
Organization/company/institution:
Address:
Town, City, State, Zip:
Email address:
Phone:
Person submitting nomination
Name:
Title:
Org/company/institution:
Address:
City, State, Zip:
Email address:
Phone:
Relationship to nominee:
Please answer the following to support your nomination of the above person.
(Use more space if needed.)
1. Indicate the l ength of service to the addiction treatment, education or research fields.
2. Detail the nominee’s support of 12-step recovery approaches.

Fr. Martin Award Nomination
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3. Describe the i mpact on others’ understanding of addiction and recovery.
4. Indicate the perceived number of people positively in fluenced by individual’s efforts.
5. List specific accomplishments that have changed the face of addiction treatment or understanding.
6. Explain how the nominee embodies teachings and philosophy of Father Joseph Martin by making recovery and helping those struggling with addiction a personal and professional passion.

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7. Provide any additional detail that you feel would aid the judges in their consideration.
Please return completed forms to Barbara Kalb, Father Martin’s Ashley, 800 Tydings Lane,
Havre de Grace, MD 21078 or email bkalb@fmashley.com or fax to 410.273.2296.
The award finalists will be confidentially notified prior to the award event.
You will receive details of the award event under separate cover.