Stacy E. Adcock

Lincoln County Environmental Health

302 N. Academy St., Suite B

Lincolnton, NC 28092

ph: 704-736-8426

fx: 704-736-8427

stacyadcock@lincolncounty.org

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Nomination for

Rookie Environmental Health Specialist of the Year

WNCPHA Environmental Health Section 

Nomination for ______________________________________________________________________

(Name of Award)

Presented by WNCPHA for _________________________________________________________________

(Calendar Year) 

Nomination by ________________________________________________________________________

(Name of Individual or agency)

____________________________________________________________________

(Title of Nominee) 

____________________________________________________________________________

(Current place of employment, with address of nominee)Education: ___________________________________________________________________________

 Public Health Experience: (Dates in time in years)

 Numbers of years worked: ________________________

 History of Employment: _____________________________________________________________________

_______________________________________________________________________________________

Organizational Affiliation:

Professional:______________________________________________________________________________

 Community: ______________________________________________________________________________

 Personal Interests: _________________________________________________________________________

 Offices held: _____________________________________________________________________________

 Appointments, important boards, commissions, committees, etc.: ______________________________________

______________________________________________________________________________________

Previous Awards: _________________________________________________________________________

List Outstanding Public Health Achievements: ______________________________________________________

________________________________________________________________________________________

(use additional sheets if necessary)

Return completed form and additional pages to Stacy Adcock by March 1:

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