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Marianne Marcus Award Nomination Form

Marianne Marcus Award Application

"*" indicates required fields

Name*
Address*
Is this address for:*
If through a mentor/colleague, please provide his/her name
Given the criteria of this award, what qualifies you for this award? Check any of the following that apply to you.

In the space provided below, in 300 words or less, please describe:

  1. Your current focal area/interests in substance use, how this fits with your current professional / student role
  2. If you indicated you are from a minority group or a minority institution, please describe
  3. Your goals as a nurse leader in this specialty area
  4. Why you are interested in attending the AMERSA National Conference and how you will disseminate what you learn to others

Max. file size: 256 MB.
Max. file size: 256 MB.
Please contact annie.potter@bmc.org with any questions.
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