Pennsylvania Association of Conservation Districts

Conservation Profiles

Help us showcase conservation leaders whose activities promote soil and water stewardship. Please provide as much information as possible. You may attach additional sheets if needed.

 Name of Individual or Organization Being Profiled:

______________________________________________________

Address: _______________________________________________

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 Phone: ________________________________________________

 Individual’s Occupation or Type of Organization/Agency:

______________________________________________________

 Conservation District affiliation: ____________________________

If an individual, does this person serve on a conservation district board?

_____ Yes _____ No

If yes, Position held: ______________________________________

# of Years: ___________________

If yes, Position held: ______________________________________

# of Years: ___________________

If yes, Position held: ______________________________________

# of Years: ___________________

Please indicate representation:

_____Public _____Farmer _____County Commissioner

This Conservation Leader should be profiled because…

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Please provide specific examples of things this Conservation Leader has done to support conservation (district) activities including major accomplishments:

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Expertise/skills that have supported conservation districts:

______________________________________________________

______________________________________________________

______________________________________________________

List conservation awards/honors received or other relevant information:

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Why is conservation work or related activities important to this person/organization? (Interview leader and provide a statement):

"_____________________________________________________

______________________________________________________

______________________________________________________

____________________________________________________."

If an organization, please specify contact:

Contact person: _________________________________________

Title: __________________________________________________

Form Submitted By:

Contact Name: __________________________________________

Title: __________________________________________________

County: ________________________________________________

Mailing Address: _________________________________________

______________________________________________________

Phone: (__________)_____________________________________

E-mail: ________________________________________________

To submit this form, you may: mail it to Shannon Wehinger, PACD, 25 North Front Street, Harrisburg, PA 17101, fax it to (717) 238-7201 or e-mail it to pacd@pacd.org.