Coastal Zone Conversion Permit Act Regulatory Advisory Committee Member Nomination Form

Please use this form to nominate individuals to serve on the Coastal Zone Conversion Permit Act Regulatory Advisory Committee. The Committee will be tasked with assisting the Department of Natural Resources and Environmental Control (DNREC) in developing regulations for the re-use of 14 sites in Delaware’s Coastal Zone, as required by the Coastal Zone Conversion Permit Act.

Nominees will be evaluated and selected based upon the attached Regulatory Advisory Committee Criteria for Membership Selection. Nominators and nominees should read these guidelines thoroughly before completing and submitting this nomination. For more information, visit

Completed nomination forms must be received by DNREC on or before March 23, 2018. Questions regarding nominations can be directed to the DNREC Division of Energy & Climate by phone at 302-735-3480, or by email at . Submit forms one of the following ways:

Mail:DNREC Division of Energy and Climate, ATTN: SusanLove 100 West Water Street, Suite5A

Dover, DE 19904



Nominee Information

Name of Nominee: ______

Nominee Contact Information

Address: ______

Phone: ______

Email: ______

Please indicate employment status, including employer if applicable:

Currently Employed

Employer: ______


Self-employed Unemployed Retired

If applicable, please indicate the organization or group this nominee will represent:


Nominator Information

Relationship to Nominee:

Self Other

If "Other," please complete the fields below:

Name of Nominator: ______

Nominator Contact Information

Address: ______

Phone: ______

Email: ______

Nomination Questionnaire

In an effort to ensure balanced representation of viewpoints and interests, DNREC will select Committee members from a variety of stakeholder groups, with distribution across four categories of interest. These categories are described below, but are not restricted to the examples given for each. Consideration will be given both to long-established groups in Delaware and newer organizations, groups, or active citizens that may represent different or emergingviews.

1.Environmental protection and public health: Environmental advocacy, environmental justice and public health groups and coalitions; public health providers; conservation organizations; environmental scientists; policy or law experts; other public service practitioners; climate change adaptation and mitigation practitioners or activists; sea level rise, land-use and sustainabilityplanners.

2.Community: Neighborhood representatives (formal or informal); municipality or county representatives; county planning and emergency management practitioners; local elected officials; individuals who reside in communities with a connection to the Coastal Zone or communities that could be affected by the redevelopment of the 14 sites. This could include communities concerned about impacts directly related to but outside of the Coastal Zone, such as transportation of hazardous materials to or from the CoastalZone.

3.Industry, business, and labor: Delaware or county business groups or trade associations; individual companies with a stake in one of the 14 sites; labor groups or unions; individual companies or industry representatives of new industries interested in siting in the Coastal Zone, including “green” industries; business consultants; lawyers or legal consultants; engineering consultants; companies who do business in or near the Coastal Zone more generally; economic development agencies (e.g. Delaware Division of Small Business, Development andTourism).

4.Other: This could include individuals with interests or technical experience not clearly represented in the categories above,including:

  • Environmentaloffsets
  • Financial Assurance
  • Tourism
  • Commercialfishing
  • Recreation

  • Religiousorganizations
  • Academia
  • Concernedcitizens
  • And more

1.Please indicate the ONE category that BEST describes the nominee based on the above stakeholder descriptions. While individuals may have interests or experience in more than one of the following categories, please select the one that best describes the capacity in which the nominee would serve on theCoastal Zone Conversion Permit Act Regulatory Advisory Committee.

Environmental protection and public health Community

Industrial, business, and labor

Other (i.e. recreation, technical, academic)

o If other, please describe:

2.Please describe how the nominee’s education, knowledge and experience fit into the category selected above. While the answer should focus on theprimary

stakeholder category indicated above, you are welcome to discuss the nominee’s connection to the other stakeholder categories (e.g. volunteer work, past employment, education, experience engaging underserved populations).

  1. Please describe the nominee’s interest in serving on the Committee and their connection to Delaware’s CoastalZone.
  1. What skills, training, traits, abilities, or experience does the nominee possess that makes them well-suited to serve on the Regulatory AdvisoryCommittee?
  1. Does the nominee have experience working with or providing outreach to fenceline, environmental justice, or underserved communities? If so, please explain.
  1. Please indicate the nominee’s experience with previous Coastal Zone Act or DNREC regulatory development processes, ifany.
  1. Please describe how the nominee will work collaboratively and respectfully in situations where participants may not agree. Provide an example of a situation in which the nominee successfully worked with parties of opposing viewpoints for a positivesolution.
  1. Additional comments or information about thenominee:

Nominee Consent

The nominee for membership to the Committee must sign below, acknowledging their nomination.

I hereby consent to this nomination for membership on the Coastal Zone Conversion Permit Act Regulatory Advisory Committee. In accepting this nomination, I acknowledge that I have read and accept the attached Regulatory Advisory Committee Criteria for Membership and Committee Member Expectations, and agree to adhere to these conditions if selected for membership. I understand that my participation in the Coastal Zone Conversion Permit Act Regulatory Advisory Committee is voluntary, and that I will not be compensated for my time or work with the Committee.

Nominee Name: ______

Nominee Signature: ______

Date: ______

Nominees are required to complete and submit the attached conflict of interest disclosure form.