Date:
Award
(Please check one):
|
o John P. Nordin Outstanding Sanitarian |
o Cind Treser Memorial Student Scholarship (Undergraduate)* |
|
o Jack Hatlen Inspirational Award |
o WSEHA Graduate Scholarship* |
|
o Environmental Health Professional of the Year Award |
o Honorary Membership |
|
o Rookie of the Year Award |
o Most Embarrassing Moment Award |
|
o Best Environmental Health Story of the Year |
|
* Please use the separate scholarship application forms.
Nominee: _____________________________________________________________________
Place of Employment: ___________________________________________________________
Why should this individual be considered for this award? (Attach a one page, or less, statement which briefly describes the nominee’s credentials.)
Please list the names and phone numbers of at least 5, but no more than 10 people who you believe would support this candidate for the recognition:
|
1. ____________________________________ |
6. ____________________________________ |
|
2. ___________________________________ |
7. ____________________________________ |
|
3. ___________________________________ |
8. ____________________________________ |
|
4. ___________________________________ |
9. ____________________________________ |
|
5. ___________________________________ |
10. ___________________________________ |
Name and address of nominator: ___________________________________________________
Phone number: ______________________ email: _____________________________________
Signature of nominator: __________________________________________________________
Note:
Many of these awards have additional documentation and application
requirements. Please follow the instructions for the individual award.