DEADLINE: NOMINATIONS MUST BE RECEIVED BY MARCH

Transcription

1 Who is eligible? CWEA members who have contributed an excess of five (5) years to the wastewater collection, design and operations objectives of CWEA are eligible for membership in the society. Service may have been completed as a CWEA or Local Section officer, Committee member or faithful volunteer at the local, regional, state or even national level. How are members selected? Nominations are accepted from individuals as well as Local Sections and CWEA committees. A select committee of Sludge Shovelers evaluates all the supporting documentation for each nominee. Only a few are selected each year. Selection is made solely on merit it is not a popularity contest. Note that scoring weight in percentages is indicated below. To nominate a deserving person, use this nomination form. The intent is for the nominator to interview the nominee and fill in the information requested during the interview. Once completed, the form can be saved and ed directly to the address below. In addition, please submit a digital photo (jpg format) of the nominee, suitable for use in an awards presentation. File size must be at least 250 kb. DEADLINE: NOMINATIONS MUST BE RECEIVED BY MARCH 1, 2016 I nominate for membership in the. A resume detailing the nominee s dedicated volunteer commitment to CWEA-related activities is attached. NOMINEE: Name of Nominee Title Employer Phone NOMINATOR: Submitted by Employer Address Daytime Phone SEND NOMINATION TO: Patrick Griffith and Norm Domingo PGriffith@lacsd.org & ndomingo@svcw.org _Nomination_Form.docx

2 5-S NOMINEE INTERVIEW FORM Membership Information CWEA Member: Enter Yes or No CWEA Member Number: Enter Member Number CWEA Member Since Enter Year first became a member Local Section Membership: WEF Member: Enter Yes or No WEF Member Number: Enter WEF Member Number Certification Information List CWEA Technical Certification Program Certificates Held (indicate discipline, grade level, and date obtained): Local Section Activities (20.6%) Local Section Board Member: Enter Yes or No List Positions and dates: Local Section Committee Member: Enter Yes or No List Committees, positions held, responsibilities, and dates: _Nomination_Form.docx Page 2 of 5

3 Other Local Section Activities, including speaker, trainer, exhibitor, etc. List activities and dates: Regional Committee Activities (20.6%) Regional (North/South) Committee Member: Enter Yes or No List Positions and dates: Other Regional Committee Member: Enter Yes or No List Committees, positions held, responsibilities, and dates: Other Regional Activities Activities, including speaker, trainer, exhibitor, etc. List activities and dates: State Level Activities (20.6%) CWEA Board Member: Enter Yes or No List Positions and Dates: _Nomination_Form.docx Page 3 of 5

4 State Committee Member: Enter Yes or No List Committees, Positions Held, Responsibilities, Activities, and Dates: Other State Level Contributions, including speaker, trainer, author, exhibitor, etc.: List activities and dates National Level Activities (14.7%) WEF Committee Member: Enter Yes or No List Committees, Positions Held, Responsibilities, and Dates Other National Level Activities, including speaker, trainer, author, exhibitor, etc. List activities and dates Awards (8.8%) Please list any awards received at local, regional, state, or national level. List award and date received. _Nomination_Form.docx Page 4 of 5

5 Other Information (14.7%) Please list any other relevant information not covered above. List activity, dates, etc. For the Nominator As you think about other valuable information, feel free to move it to sections listed above if applicable. Humorous Information About Nominee Please provide 2-3 humorous or offbeat items about the nominee. This information is intended to be used by the Committee in the Induction Ceremony at the Annual Conference. Nomination_Form.docx Page 5 of 5