CWEA Nomination Form
Laboratory Committee
Person of the Year Award
Nominator:
Nominee:
Name:
Name:
Agency:
Agency:
Address:
Address:
City, Zip Code:
City, Zip Code:
Work Phone:
Work Phone:
Fax:
Fax:
Email Address:
Email Address:
Local Section:
Local Section:
Checklist of Awards Criteria:
You must include all of the following to be eligible for the award.
 Nominee must be a CWEA member; proof of membership is required.
 Nominee must be, or have been employed in laboratory where the principal activity
is wastewater analysis.
 CWEA Laboratory Analyst Certification.
 Include four copies of the nomination packet.
 Highly desirable: a record of service to CWEA and/or one of its Local Sections.
 Note: Laboratory Supervisors are not eligible for this award.
Nominator Instructions:
1. All nominations must use the attached form. Other formats will not be accepted.
2. Application data must be from your agency’s prior fiscal year.
3. Submitted materials will not be returned.
4. Submit this nomination form and all attachments to your local section awards
chair/contact by the awards deadline given below:
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CWEA Nomination Form
Laboratory Committee
Person of the Year Award
Central San Joaquin (CSJ)
Deadline: November 1, 2015
Awards Chair: Thomas Adams
5607 West Jensen Ave.
Fresno, CA 93706
tom.adams@fresno.gov, 559-621-5140
Colorado Basin Section (CORBS)
Deadline: November 13, 2015
Awards Chair: Mark Graham
68380 Moonlight Dr.
Cathedral City, CA 92234
mgraham@dc.rr.com, 760-328-6896
Desert and Mountain (DAMS)
Deadline: October 2, 2015
Awards Chair: Kim Booth, BBRWA
121 Palomino Dr. P.O. Box 517
Big Bear City, CA 92314
kbooth@bbarwa.org, 909-584-4018
Golden Empire Section (GES)
Deadline: Contact local section
Awards Chair: Mike Popichak
PO Box 9956
Bakersfield, CA 93389
cacoolmike@aol.com, 661-979-3276
Los Angeles Basin Section (LABS)
Deadline: November 20, 2015
Awards Chair: Miluska Propersi, RMC
Water and Environment
2400 Broadway Suite 300
Santa Monica, CA 90404
mpprpersi@rmcwater.com,
310-566-6460
Monterey Bay Section
Deadline: October 1, 2015
Awards Chair: Jackie McCloud, City of
Watsonville
500 Clearwater Ln.
Wastonville, CA 95076
Jackie.mccloud@cityofwatstonville.org,
831-768-3172
North Coast Section (NCS)
Deadline: Contact local section
Awards Chair: T.K. Williams
2752 Hillcrest Dr.
Eureka, CA 95503teekaywilliams.@gmail.com, 323-2577749
Northern Sacramento Valley (NSV)
Deadline: October 30, 2015
Awards Chair: Nolan Randall
111 Main St.
Palm Springs, CA 99999
nolan.randall@ch2m.com, 530-229-3341
Northern San Joaquin Section (NSJ)
Deadline: October 30, 2015
Awards Chair: Bonnie Dennedy
17103 West Bethany Road
Mountain House, CA 95391
bonita.dennedy@stservices.com,
209-836-3351
Redwood Empire Section (RES)
Deadline: Contact local section
Awards Chair: Rodrigo Montanez
4539 Crimson Clover Dr.
Fairfield, CA 94534
rmontanez@napasan.com, 707-258-6083
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CWEA Nomination Form
Laboratory Committee
Person of the Year
Sacramento Area Section (SAC)
Deadline: Contact local section
Awards Chair: Debi Lewis
3321 Power Inn Road STE 300
Sacramento, CA 95826
debi.m.lewis@mwhglobal.com,
916-418-8293
San Francisco Bay (SFB)
Deadline: October 15, 2015
Awards Chair: Steve Dominguez, Veolia
3000 Airport Rd.
Rio Vista, CA 94571
steven.dominguez@veolia.com,
707-374-2633
Santa Clara Valley Section (SCV)
Deadline: Contact local section
Awards Chair: Sid Nash
1567 Kooser Road
San Jose, CA 95118
sid@ableseptic.com, 408-515-3084
Tri-Counties Section
Deadline: Contact local section
Awards Chair: Thomas Welch
520 E. Yanonali
Santa Barbara, CA 93103
twelche@santabarbaraca.gov,
805-568-1002
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San Diego Section (SD)
Deadline: November 20, 2015
Awards Chair: Steve Jepsen, DUDEK
605 Third Street
Encinitas, CA 92024
sjepsen@dudek.com, 760-415-4332
Santa Ana River Basin (SARBS)
Deadline: November 6, 2015
Awards Chair: Megan Yoo Schneider,
Moulton Niguel Water District
27500 La Paz Road
Laguna Niguel, CA 92677
mschneider@mnwd.com, 949-448-4020
Sierra Section
Deadline: November 5, 2015
Awards Chair: Evy Henkel
PO Box 1609
Truckee, CA 96160
evymtnlover@hotmail.com,
530-277-4887
Go to myCWEA.org and click on Local
Section on the menu to learn more about
each local section.
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CWEA Nomination Form
Laboratory Committee
Person of the Year
Local Section Instructions
1. No more than one nomination for the Laboratory Award may be submitted by each
Local
2. Section as their Local Section Winner. Submittal of more than one nomination will
invalidate that Local Section’s entry.
3. The CWEA Laboratory Awards are coordinated by the CWEA Laboratory Committee.
The team is comprised of the Awards Subcommittee Chair, Committee Chair, and
equal representation from the Northern and Southern regions.
4. The committee will evaluate all nominees for this award.
5. All award nominees will be notified of their award status prior to the CWEA Annual
Conference.
6. Send State Award Nominations to CWEA Awards program, 7677 Oakport Street,
Suite 600, Oakland, CA 94621 or email to awards@cwea.org as a pdf. Other file
formats will not be accepted.
7. All State awards must be received by FRIDAY, January 8, 2016. Postmarks will not
be accepted.
Questions:
Call Giti Heravian, Laboratory Awards Chair, (707) 428-9153 or gheravian@fssd.com.
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CWEA Nomination Form
Laboratory Committee
Person of the Year
TO BE COMPLETED BY NOMINATOR
I.
NOMINEE:
A.
Name of Nominee:
Job Title:
Years in position:
Employer:
Supervisor:
B.
Local Section Member:
Yes
No
Years:
CWEA Laboratory Analyst Certification:
Yes
CWEA Member (Required):
WEF Member:
Yes
Yes
No
No
No
Grade:
Years:
Years:
Other Memberships (AWWA, etc.) Please list:
C.
II.
List previous awards:
SUGGESTED AWARD CRITERIA:
*Note: Attach additional information if needed.
A.
Describe nominee’s job; include his/her functions and relationship to other
employees.
B.
What has this nominee done to improve the functioning of the work group?
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CWEA Nomination Form
Laboratory Committee
Person of the Year
C.
How has the nominee been active at the Local Section?
D.
How has the nominee been active at the State (CWEA or other) level?
E.
What professional accomplishments has the nominee achieved related to this
award (i.e., publication, presentations, etc.)?
F.
List any relevant educational background and other training classes.
G.
List any relevant past work experience.
H.
Any other comments relating to this person’s nomination?
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CWEA Nomination Form
Laboratory Committee
Person of the Year
LABORATORY PERSON OF THE YEAR SCORE SHEET
NOMINEE’S NAME:
Years in Position
1
2
3
4
5
6
7
8
9
Lab. Certification
1
2
3
4
5
6
7
8
9
Professional Mem. 1
2
3
4
5
6
7
8
9
Job Functions/
Relationship to
Other Employees
1
2
3
4
5
6
7
8
9
Improvement to
Work Group
Function
1
2
3
4
5
6
7
8
9
CWEA Local
Activity
1
2
3
4
5
6
7
8
9
CWEA State
Activity
1
2
3
4
5
6
7
8
9
Professional
Accomplishments
1
2
3
4
5
6
7
8
9
Educational &
Training Classes
1
2
3
4
5
6
7
8
9
Relevant Past Work
Experience
1
2
3
4
5
6
7
8
9
Nomination
2
3
4
5
6
7
8
9
1
Summary
TOTAL POINTS
TOTAL POSSIBLE
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99
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CWEA Nomination Form
Laboratory Committee
Person of the Year
%
Rated by :
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Date :
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