NATIONAL CAPITAL AREA

ENVIRONMENTAL HEALTH ASSOCIATION

NOMINATION FORM

JERROLD M. MICHAEL AWARD

(ENVIRONMENTAL HEALTH PROFESSIONAL OF THE YEAR)

Name of Nominee: _________________________________________________

Job Title: _________________________________________________

Employer: _________________________________________________

Please attach a brief (one page or less) explanation of the reasons you believe the above named individual should be selected as this year’s Jerrold Michael winner. Specifically describe how this person has contributed to his or her employer’s environmental health mission, to the goals of the National Capital Area Environmental Health Association, and to the advancement of the environmental health profession.

THE NOMINATION COMMITTEE MAY CONTACT YOU FOR ADDITIIONAL INFORAMTION.

NOMINATED BY: (Signatures of 2 NCAEHA Members)

Name:	Title:
Address:	Phone:
	E-Mail:

Name:	Title:
Address:	Phone:
	E-Mail:

Nominations must be received by May 1, 2008.

Alexandria Health Department

Attn: Patrick Jones

4480 King Street, 3rd Floor

Alexandria, VA 22302

Return to Main Page