2020-mary-mayhew-award-nomination-formrev4

2020 MARY MAYHEW PRACTITIONER AWARD The Mary Mayhew Practitioner Award recognizes New Hampshire individuals for their vision and leadership in ending gender-based violence, including sexual and relationship violence and stalking This award is named in honor of Mary Mayhew, one of the five founders of the Prevention Innovations Research Center Mary devoted her professional career and personal life to working on issues directly related to violence against women Her remarkable contributions to the field are numerous, most notably through her outstanding leadership as Director of the Sexual Harassment and Rape Prevention Program (SHARPP) located on the UNH campus and as Executive Director of Starting Point: Services for Victims of Domestic & Sexual Violence We are proud to recognize Mary’s dedication, compassion, and legacy of service with this award SELECTION CRITERIA The MARY MAYHEW PRACTITIONER AWARD is presented to an individual who has worked to end gender-based violence and stalking in New Hampshire While all the criteria listed below must be demonstrated in the body of work of the award recipient, it is not required that all of the criteria be met through work in New Hampshire The MARY MAYHEW PRACTITIONER AWARD is presented to an individual who has:  Advanced the field through evidence-based practice  Improved the prevention and response of systems to gender-based violence, including sexual and relationship violence and stalking  Increased public awareness and knowledge about the incidence, causes and contributing factors, and nature of sexual and relationship violence and stalking  An understanding of the effects of trauma on victims  The ability to address existing problems and gaps in prevention, services or other responses with innovative trauma-informed solutions  An understanding of gender-based violence, including sexual and relationship violence and stalking as social justice issues AWARD NOMINATION NARRATIVE In 750 words or less (PDF or Word), explain candidate’s outstanding service, providing specific examples for two of the selection criteria, and the impact of their work* 2020 MARY MAYHEW PRACTITIONER AWARD NOMINATION FORM NOMINEE Name: Click here to enter text Street Address: Click here to enter text Work Email Address: Click here to enter text Current Place of Employment: Click here to enter text REFERENCES Phone Number: Click here to enter text City/State/Zip Code: Click here to enter text Personal Email Address: Click here to enter text Position Title: Click here to enter text List two people who are familiar with the nominee's achievements and who are willing to be contacted by the selection committee to provide a reference Reference Name: Click here to enter text Place of Employment & Title: Email Address: Place of Employment & Title: Email Address: Click here to enter text Click here to enter text Reference Name: Click here to enter text Click here to enter text Click here to enter text Phone Number: Click here to enter text Phone Number: Click here to enter text NOMINATING ORGANIZATION OR INDIVIDUAL Organization’s Name: Click here to enter text Contact Person Name: Click here to enter text Contact Person Daytime Phone Number: Click here to enter text Organization City: Click here to enter text Contact Person Title: Click here to enter text Contact Person Email Address: Click here to enter text ☐ Contact person should check this box to indicate that s/he attests that the information contained in this application is true to the best of her/his knowledge and the Nominating Organization has authorized this Nomination EMAIL NOMINATION PACKAGE Submit this nomination form, the nomination narrative, and candidate’s bio or resume via email, no later than Monday, June 1st, 2020 to: Prevention.Innovations@unh.edu Please include Award Nomination in the subject line