George Warren Fuller Award 2023

George Warren Fuller Award

SECTION 1
Nominator Information Please complete the following information for the person completing this nomination.
Nominator Full Name *
Nominator Organization *
Nominator Professional Title
Nominator Address (Include City, State, and Zip) *
Nominator Phone *
Nominator Email Address *
SECTION 2
Nominee Contact Information Complete the following fields related to the person being nominated for the award.
Nominee Full Name *
Nominee Employer *
Nominee Professional Title
Nominee Address (Include City, State, and Zip) *
Nominee Phone *
Nominee Email Address *
SECTION 3
Nominee Professional Information Complete the following fields related to the nominee's certifications and membership. When listing involvement with AWWA, WEF, and NC One Water, include activity with the national AWWA and national WEF in the AWWA Involvement and WEF Involvement fields. Participation within North Carolina should be listed in the NC One Water Involvement field. If you would prefer, you may answer questions in a Word document, convert the document to a PDF file, and upload the responses with your nomination.
Certifications Held (Include Type and Level)
Current Memberships (select all that apply)	AWWA WEF NC SLAM
AWWA Involvement *
Year Joined AWWA *
WEF Involvement
NC One Water Involvement
SECTION 4
Education and Employment History Please use this section to briefly describe your educational background and recent employment history.
Education Experience 1 (College, Degree, Year Graduated) *
Education Experience 2 (College, Degree, Year Graduated)
Education Experience 3 (College, Degree, Year Graduated)
Employment History *
SECTION 5
Professional Memberships Use the fields below to specify any Civic or Professional Organization that you are an active member of.
Civic Organization Memberships (Lions, Kiwanis, School Board, etc.)
Professional Organization Memberships
SECTION 6
Professional Accomplishments Please list all honors and awards, along with three publications. If you have any additional professional accomplishments, you may attach those as a document below.
Professional Awards / Honors (include year received and awarding organization identity)
Publication 1
Publication 2
Publication 3
SECTION 7 (TO BE COMPLETED BY NOMINATOR)
Eligibility and Recommendation Use the space below to provide additional reasoning as to why this individual is deserving of the award. If you need to attach additional documentation, you may do so below.
Provide details of the nominee’s “distinguished service in the water supply field” *
Citation: Provide a recommended citation of 40 words or less *	40 of 40 characters remaining
SECTION 8
Uploading Supporting Documents If you would like to upload responses to open-ended questions, or additional materials, please convert them to PDF format and merge all documents into a clearly labeled file.
Upload any additional documents