Young Woman

LOUISIANA CONFERENCE ON WATER SUPPLY, SEWERAGE, AND INDUSTRIAL WASTES, INC.

OUTSTANDING YOUNG WOMAN AWARD

NOMINATION FORM

The Outstanding Young Woman of the Year Award is awarded not more than annually to a young woman in the age group up to and including 35 years of age who has demonstrated ability and leadership in conference activities.

The purpose of honoring conference members with this award is to recognize outstanding contributions of time and effort and to encourage and inspire other young women to likewise serve the public good and the conference.

Date:

____________________

1. Nomination submitted by:

_________________________________________________________________________

2. Name of Nominee:

_________________________________________________________________________

3. Address:

_________________________________________________________________________

4. Present Employer:

_________________________________________________________________________

5. Title of Present Position:

_________________________________________________________________________

6. Certification Status: Louisiana Classification:

_________________________________________________________________________

Field:

_________________________________________________________________________

7. Education and Training:

_________________________________________________________________________

8. Experience in Water Supply, Sewerage or Industrial Wastes Fields:

_________________________________________________________________________

9. Other Honors Received:

_________________________________________________________________________

10. Comments:

_________________________________________________________________________