Operators Award Nomination Form

Mitchell (water) or Chambers (wastewater) Award:

Member of KWWOA in good standing with ten years or more of professional involvement in the water or wastewater industry, has demonstrated a commitment to the improvement of the management and the technical progression of operation, maintenance, water quality or water dependent quality.

Nicholas Award:

Same criteria as above with added emphasis on the involvement in the advancement of water and/or wastewater operator education.

Which award is this nomination for?*
- Mitchell
- Chambers
- Nicholas
Nominee's Full Name*
First Last
Chapter*
- Western
- Central
- North Central
- Eastern
Employer*
Address*
Street Address Address Line 2 City State Zip Code
Name of Nominee's Supervisor*
Supervisor's Email*
Supervisor's Phone Number*
Job Title & Duties of Nominee*
Number of Years of Service*
Educational Background*
Certification(s) and Experience*
Number of KWWOA Membership Years*
Years of Service*
Describe any involvement with KWWOA*
Nomination Submitted By:
Full Name*
First Last
Email*
Phone*

Operators Award Nomination Form

Nomination Submitted By:

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