2023 Social Worker of the Year Nomination Form

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*Applications due April 25, 2022
Please take a few moments to nominate a colleague for Social Worker of the Year which recognizes current
members or non-members for their contributions to clinical social work in the state of North Carolina. The
winner will be recognized at the spring Ethics conference and press releases will be submitted to local papers.
You may use this form or write a letter of endorsement. Letters of endorsement can be emailed to admin@ncscsw.org.

Nominees Name: *

Nominees Contact Information: Please include their phone number(s) & email address. *

Brief Description of Current or Most Recent Job (with employment dates): *

History of Employment and/or Volunteer Experience (with employment dates): *

Discuss How This Nominee Has Contributed to the Advancement of the Clinical Social Work Profession. *

Nominators Name: *

Please provide your (the nominators) contact information include your email address, phone number(s), and relationship to nominee. *

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