No. 3.9 Rev. 3

Page 2 of 11

The American Society for Quality Energy and Environmental Division Awards Program provides recognition to individuals or organizations who have made an outstanding contribution to quality in activities related to energy or the environment, or have given significant service to the division. Members of the division must complete the attached award application forms and submitted them to the Division Secretary, Greg Merkel by June 14, 2007. The types of awards available are:

TYPES OF AWARDS

ENERGY AND ENVIRONMENTAL
QUALITY AWARDS
QUALITY IN ENERGY AWARD
One nominee from within the energy industry who has shown continuing leadership and service over an extended time period.
QUALITY IN THE ENVIRONMENT AWARD
One nominee from within the environmental community who has shown continuing leadership and service over an extended time period. / ENERGY AND ENVIRONMENTAL DIVISION AWARDS
BASILE AWARD
One nominee who has shown continuing leadership and service to the Division for an extended period of time.
QA PERSON OF THE YEAR
One nominee who has shown a significant contribution to the Division during the previous fiscal year.
DIVISION AWARD (Worker)
One nominee who has been a member of the Division for more than 10 years and has shown dedication to the Division through continuous service and support.
REGIONAL COUNCILOR OF THE YEAR
One nominee who has shown a significant contribution to the Division during the previous fiscal year through implementation of the Regional Councilor's Management Program.
SERVICE AWARD
One nominee who has shown dedication to the Division though significant service over the pre-vious fiscal year.
CONFERENCE CHAIRS*
OUTGOING DIVISION CHAIR*
OUTGOING COMMITTEE CHAIRS*
* Automatically Chosen


EED

ENERGY AND ENVIRONMENTAL DIVISION AWARD

APPLICATION FORM Page 1 of 2

AWARD: / __ Basile / __ QA Person of Year / __ Division / __ Service / __ Reg. Councilor
NAME: / DATE:
POSITION: / COMPANY:
ADDRESS: / TEL. No.: W)
ASQ No: / JOINED:
These services and/or leadership qualities should be measurable activities performed within and for the Division. Specifically excluded are contributions to energy or environmental organizations.
I. DIVISION SERVICES/ACCOMPLISHMENTS *1 2 3 4 5 6 7 8 9 10
II. DURATION OF SERVICE/ACCOMPLISHMENTS 1 2 3 4 5 6 7 8 9 10
III. LEADERSHIP ROLE 1 2 3 4 5 6 7 8 9 10
IV. COMMUNICATION/INTERFACE WITH OTHERS 1 2 3 4 5 6 7 8 9 10

* Ratings for Committee use only.

July, 1997

EED

ENERGY AND ENVIRONMENTAL DIVISION AWARD

APPLICATION FORM

NAME: ______Page 2 of 2

V. DIVISION PUBLISHED DOCUMENTS 1 2 3 4 5 6 7 8 9 10
VI. IMPACT ON DIVISION MEMBERSHIP 1 2 3 4 5 6 7 8 9 10
VII. ADDITIONAL SERVICE TO THE DIVISION 1 2 3 4 5 6 7 8 9 10
DATE: ______SUBMITTED BY: ______
ASQ No.: ______TEL. No.: (H) ______(W) ______
POSITION: ______COMPANY:______
ADDRESS:______
______
THREE DIVISION REFERENCES FOR ACHIEVEMENTS:
1. ______
Name Title/Co. Tel. No.
2. ______
Name Title/Co. Tel. No.
3. ______Name Title/Co. Tel. No.

No. 3.9 Rev. 3

Page 5 of 11

EED

QUALITY IN ENERGY OR THE ENVIRONMENT AWARD

APPLICATION FORM Page 1 of 2

AWARD: / ____ Energy / ____ Environment
NAME: / DATE:
POSITION: / COMPANY:
ADDRESS: / TEL. No: (W)
ASQ No: / JOINED:
These contributions and achievements should be measurable activities related to quality within energy/environmental related companies/organizations. Specifically excluded are service or contributions to ASQ related work activities including the Energy and Environmental Division.
I. INDUSTRY ACTIVITIES/PROJECTS *1 2 3 4 5 6 7 8 9 10
II. DURATION OF ACTIVITIES/PROJECTS 1 2 3 4 5 6 7 8 9 10
III. LEADERSHIP CONTRIBUTIONS 1 2 3 4 5 6 7 8 9 10
IV. COMMUNICATION/INTERFACE WITH OTHERS 1 2 3 4 5 6 7 8 9 10

* Ratings for Committee use only.

July, 1997

EED

QUALITY IN ENERGY OR THE ENVIRONMENT AWARD

APPLICATION FORM

NAME: ______Page 2 of 2

V. PROFESSIONAL CONTRIBUTIONS 1 2 3 4 5 6 7 8 9 10
VI. INDUSTRY PUBLISHED DOCUMENTS 1 2 3 4 5 6 7 8 9 10
(Excluding Division Documents)
VII. IMPACT ON INDUSTRY/EMPLOYEES 1 2 3 4 5 6 7 8 9 10
VIII. ADDITIONAL CONTRIBUTIONS TO INDUSTRY 1 2 3 4 5 6 7 8 9 10
DATE: ______SUBMITTED BY: ______
ASQ No.:______TEL. No.: (H) ______(W) ______
POSITION:______COMPANY: ______
ADDRESS: ______
______
THREE DIVISION REFERENCES FOR ACHIEVEMENTS:
1. ______
Name Title/Co. Tel. No.
2. ______
Name Title/Co. Tel. No.
3. ______Name Title/Co. Tel. No.