2025 CHADD Hall of Fame Award Nomination Form

Welcome to the nomination process for the CHADD Hall of Fame Award!

This prestigious award recognizes individuals who have demonstrated outstanding service and contributions in support of CHADD’s mission. Our goal is to honor those whose work in research, practice, and service has made a significant impact in fields such as public policy, medicine, media, legal, coaching, community engagement, psychology, and education.

Please complete this form in its entirety for consideration.

Deadline to Submit: May 19, 2025

Question Title

* 1. Nominator Information:

Your Name:

Your Title:

Your Relationship to the Nominee:

Your Email Address:

Your Phone Number:

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* 2. Nominee Information:

Name:

Professional Affiliation:

Title:

Email Address:

Phone Number:

Question Title

* 3. Eligibility Criteria:
Please confirm the following (Yes/No/Unknown):

	YES	NO	UNKNOWN
The nominee has demonstrated outstanding and significant service in support of CHADD’s mission.	The nominee has demonstrated outstanding and significant service in support of CHADD’s mission. YES	The nominee has demonstrated outstanding and significant service in support of CHADD’s mission. NO	The nominee has demonstrated outstanding and significant service in support of CHADD’s mission. UNKNOWN
The nominee's contributions are in the area of research, practice, or both.	The nominee's contributions are in the area of research, practice, or both. YES	The nominee's contributions are in the area of research, practice, or both. NO	The nominee's contributions are in the area of research, practice, or both. UNKNOWN
The nominee has made outstanding contributions in one or more fields of service (e.g., public policy, medicine, psychology, education).	The nominee has made outstanding contributions in one or more fields of service (e.g., public policy, medicine, psychology, education). YES	The nominee has made outstanding contributions in one or more fields of service (e.g., public policy, medicine, psychology, education). NO	The nominee has made outstanding contributions in one or more fields of service (e.g., public policy, medicine, psychology, education). UNKNOWN

Question Title

* 4. Fields of Service:
Please select the field(s) of service that best describe the nominee's contributions:

Public Policy

Medicine

Psychology

Education

Chapter Services

Legal

Media

Community Engagement

Peer Support

Coaching

Other (please specify):

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* 5. Description of Contributions:
Provide a detailed description of the nominee’s contributions. Include specific projects, initiatives, or research, highlighting their significance and impact.

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* 6. Impact of Contributions:
Describe the impact of the nominee’s contributions on CHADD’s mission, their field, and/or the broader community. Include any relevant outcomes or recognitions.

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* 7. Recognition and Awards (Optional):
List any awards or recognitions the nominee has received for their contributions.

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* 8. Supporting Documentation:
Please attach any documents, publications, or links that support the nomination. You may also list the contact information of two references who can speak to the nominee's qualifications and contributions. (File size limit is 16MB.)

PDF, DOC, DOCX, PNG, JPG, JPEG file types only.

Choose File

Please review your nomination before submitting. Once submitted, the nomination cannot be edited. If you have any additional questions, comments or concerns regarding the nomination, please reach out to [email protected].

2025 CHADD Hall of Fame Award Nomination Form

Question Title

* 1. Nominator Information:

Question Title

* 2. Nominee Information:

Question Title

* 3. Eligibility Criteria:Please confirm the following (Yes/No/Unknown):

Question Title

* 4. Fields of Service:Please select the field(s) of service that best describe the nominee's contributions:

Question Title

* 5. Description of Contributions: Provide a detailed description of the nominee’s contributions. Include specific projects, initiatives, or research, highlighting their significance and impact.

Question Title

* 6. Impact of Contributions:Describe the impact of the nominee’s contributions on CHADD’s mission, their field, and/or the broader community. Include any relevant outcomes or recognitions.

Question Title

* 7. Recognition and Awards (Optional): List any awards or recognitions the nominee has received for their contributions.

Question Title

* 8. Supporting Documentation: Please attach any documents, publications, or links that support the nomination. You may also list the contact information of two references who can speak to the nominee's qualifications and contributions. (File size limit is 16MB.)

* 3. Eligibility Criteria:
Please confirm the following (Yes/No/Unknown):

* 4. Fields of Service:
Please select the field(s) of service that best describe the nominee's contributions:

* 5. Description of Contributions:
Provide a detailed description of the nominee’s contributions. Include specific projects, initiatives, or research, highlighting their significance and impact.

* 6. Impact of Contributions:
Describe the impact of the nominee’s contributions on CHADD’s mission, their field, and/or the broader community. Include any relevant outcomes or recognitions.

* 7. Recognition and Awards (Optional):
List any awards or recognitions the nominee has received for their contributions.

* 8. Supporting Documentation:
Please attach any documents, publications, or links that support the nomination. You may also list the contact information of two references who can speak to the nominee's qualifications and contributions. (File size limit is 16MB.)