Leadership in Conservation

Thank you for taking the time to recognize the fantastic work that DEW employees do in order to maintain our State’s natural resources for all to enjoy. Please complete this form and return along with any additional material such as newspaper articles, screen shots of social media articles and posts, work on websites, project notes, reports, photographs etc. that will substantiate your nomination. Details of how to submit your nomination are provided at the end of this application.

You may either type directly into the on-line form on this page or save the document form below.

Download Leadership in Conservation – nomination form

Name of Nominee(Required)

First Last

Position(Required)

Nominee Address

Street Address Address Line 2 City State Post Code

Nominee Mobile phone number(Required)

Nominee Email(Required)

Nominated by:

Nominated by Name(Required)

First Last

Friends group / position

Nominated by Address

Street Address Address Line 2 City State Post Code

Mobile Number for Nominated(Required)

Nominated by Email(Required)

Please list up to two people who can act as referees for this nomination

Referee 1 name(Required)

First Last

Referee 1 title(Required)

Referee 1 address

Street Address Address Line 2 City State Post Code

Referee 1 mobile number(Required)

Referee 1 email(Required)

Referee 2 name(Required)

First Last

Referee 2 title

Referee 2 address

Street Address Address Line 2 City State Post Code

Referee 2 mobile number(Required)

Referee 2 email(Required)

Is the nominee aware of the nomination?(Required)

Yes

please type date

NOMINATION STATEMENT

ACHIEVEMENT How has the nominee demonstrated "Outstanding Service"?(Required)

Please describe how the nominee has demonstrated “Outstanding Service” For example, how have they shown innovation in program or technique, excelled in leadership or project development. Please enter your response below – no word limit.

IMPACT: How has the nominee’s contribution impacted their group and those they work with? What are the broader outcomes of the nominee’s work?(Required)

Please describe how the nominee’s efforts have influenced people and results in both the short term and over the longer term. You may include examples of projects undertaken and how they have affected colleagues and volunteers as well as the environment itself.

ANY OTHER INFORMATION

Please provide any additional detail you wish to include to support your nomination

You can upload photos or pdf

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