Awards Program Candidate Information Form Award Name*Select AwardAlfred E. Peloquin AwardArthur Sidney Bedell AwardAsset Management Excellence AwardBiosolids Management AwardClair N. Sawyer AwardCommittee Service AwardE. Sherman Chase AwardElizabeth Cutone Executive Leadership AwardEnergy Management Achievement AwardFounders AwardGeorge W. Burke, Jr. Safety AwardLaboratory Analyst Excellence AwardOperator AwardPaul Keough AwardPublic Educator AwardWilliam D. Hatfield AwardYoung Professional AwardCandidate's Name (as it will appear on award)*Candidate's Title*Candidate's Company/Affiliation*Candidate's Telephone*Candidate's EmailCandidate's Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Sponsor's Name (name of committee, state association, individual, etc.)*Sponsor's Company/Affiliation*Sponsor's Telephone*Sponsor's Email* Please verify your EmailIs this a confidential nomination?*YesNoAn active NEWEA/WEF membership is required for award nominations. Contact NEWEA at 781-939-0908 for their Membership ID# if not known. The NEWEA Membership ID # is the same as the WEF ID #. The Asset Mgmt, Energy Mgmt and Keough Awards are exempt from this requirement.Candidate's NEWEA Membership ID #Basis for Award Summary (75 words or less):*Provide a description of specific reasons why the candidate is being nominated for this award (i.e. relevant association and work-related accomplishments). Additional supporting information relative to this nomination can be attached below.Supporting information (if desired) Drop files here or Accepted file types: pdf, doc, docx, jpg, gif, png. Candidate's Biographical Info (75 words or less)*Provide a brief biographical summary of the candidate's relevant professional experience. Additional information, such as a resume, can be provided below.Supporting information (if desired) Drop files here or Accepted file types: pdf, doc, docx, jpg, gif, png.