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​Who stood by you through your darkest

moments, was there for you and continues to;

~empower you when you don't feel strong,

~support you through the good and the bad times, and

~encourage you as you build your life in recovery? 

​

Please tell us about them!  ​

Recovery Super-Hero
Nomination Form

1.A. Tell us about your Recovery SuperHero (The Nominee)

1.B. How would you like your Recovery Super-Hero's Name to be personalized on their Certificate? (Choose one option.)

For Notification & Consent Purposes ONLY

For Notification & Consent Purposes ONLY

4. Tell us about your Recovery Super-Hero!

Be as descriptive as you can - this individual is an inspiration and is setting an example for other friends/family/community members who want to support 'one of us' (people who are living in recovery).

PLEASE NOTE: DO NOT UPLOAD PHOTOS THAT YOU WISH TO KEEP PRIVATE. " By uploading this photograph, I hereby give PEER Wellness Center permission to share this/these photo(s) publicly on their website and social media channels to inspire the community."

5.Do you have any advice for someone who may still be struggling with their recovery and/or their friends/family/employers who want to help and support them?

6. Tell us about you! 7.-8. Please provide your eMail and Phone # so that we can contact you.

For Notification purposes ONLY!

For Notification purposes ONLY!

9. How would you like this award to be presented to your SuperHero?

Please choose 1 option below:
I would like to personally present this award at the Recovery Super-Hero Awards Event.
I would like the Master of Ceremonies to present this award at the Recovery Super-Hero Awards Event.
I would rather present this award to my Recovery Super-Hero privately.
Other

10. (Last question... we promise) But A VERY IMPORTANT one!

We absolutely respect your anonymity and right to privacy. We will NEVER share any of your personal and federally protected information without your express and written permission. EVER. (Please choose one option below.)
Yes - you have my permission to publically share my FULL NAME. on the Recovery Wall Of Fame webpage.
Yes - you have my permission to publically share my FIRST NAME only on the Recovery Wall Of Fame webpage.
Yes - you have my permission to publically share my INITIALS only on the Recovery Wall Of Fame webpage.
No. PLEASE DO NOT PUBLICALLY SHARE MY NAME, MY INITIALS OR ANY OTHER PERSONALLY IDENTIFYING INFORMATION ON THE RECOVERY WALL OF FAME WEBPAGE.

Do you know your rights? We do! Learn more by reviewing the new Fact Sheet 42 CFR Part 2 Final Rule  regarding a person's Confidentiality Protections that address concerns that discrimination and fear of prosecution deter people from entering treatment for Substance Use Disorder (SUD) (updated 01/30/2026) from the US Department of Health & Human Services.

PLEASE NOTE: NO PUBLIC DISCLOSURE IS REQUIRED IN ORDER TO PARTICIPATE IN THE "RECOVERY SUPER-HERO" EVENT.

Every individual who is nominated and every individual who submits the nomination are eligible to receive their Recognition Award and participatory gifts of appreciation.

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