JV Stewardship Award Nomination Form

Southeastern Cave Conservancy, Inc.

John Van Swearingen IV Stewardship Award

Nomination Form

Nominations must be submitted by September 25
Mail completed nomination forms to award committee chairman Jim Wilbanks at:

SCCi JV Award Committee c/o Jim Wilbanks
PO Box 34
Rising Fawn GA 30738-0034

Submissions by email are also acceptable, but must use the MS Word format award nomination from.

1. Date of Nomination: ___________________________________________

2. Nominator's Name: ___________________________________________

3. Nominator's address:
______________________________________________________________
______________________________________________________________
______________________________________________________________

4. Nominator's Telephone #: _____________________________________

5. Nominator's Email Address: _____________________________________

6. Nominator's SCCi Member #: _____________________________________

7. Name of the Nominee: _____________________________________

8. Nominee's address:
______________________________________________________________
______________________________________________________________
______________________________________________________________

9. Nominee's Telephone #: _____________________________________

10. Nominee's Email Address: _____________________________________

11. Period of Stewardship Activity by the Nominee:

(In format of MM/YY - MM/YY) ________________________________

12. Describe the Stewardship Activity and the specific location (cave, property, county, state) where the action(s) were performed. (Please attach additional page(s) if more space is required):

______________________________________________________________

13. Did the nominee personally carry out all of the activities described in Item 12 above? (Please indicate by checking either yes or no below)

Yes _____ No ______

14. If the response to Item 13 is NO, please list the name of other participating individuals and how they assisted with the activity and their participation period (MM/YY-MM/YY).

______________________________________________________________

15. Briefly describe the benefits to the caving community derived from the stewardship activity performed by the nominee.

______________________________________________________________

16. Describe any adversities, if any, that had to be overcome to conduct the stewardship activity.

______________________________________________________________

17. Describe the innovative or unique techniques, if any, utilized by the nominee to carry out the stewardship activity.

______________________________________________________________

The nominator, as undersigned below, affirms that all information submitted is true and correct. The undersigned further acknowledges that the decision of the award committee is based on submitted data and its decision is final.

(Signature) ________________________________________________

(Date) ________________________