NCASWCD Memorial Information Form
Please complete the questions below for the deceased and click submit to send memorial information to recognize a member of the NC Soil and Water Conservation partnership.  

Questions marked with an * are required; also please note the text that denotes the format in which responses are requested.

A copy of the obituary and a high quality digital photo of the individual should be submitted to ncmemorialservice@gmail.com, the subject line of the email should be the name of the deceased.  It is important that a high quality image be submitted; low resolution images do not display well when projected on the screen during the NCASWCD Memorial Service.

Please contact Bryan Evans with any questions at - 919.707.3767.
Thank you.
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SWCD name *
Name of deceased *
First name
Name of deceased
Middle name
Name of deceased *
Last name
Name of deceased
Nickname (if applicable)
Date of birth *
Format - mm/dd/yyyy
Date of death *
Format - mm/dd/yyyy
Occupation *
Occupation or previous occupation if retired
Previous role(s) with NC Soil and Water Conservation *
Example: District Supervisor, District Staff, NRCS, DSWC
Length of service *
Format - yyyy (start year) through yyyy (end year) = XXXX total years; if deceased served NC Soil and Water Conservation in more than one capacity, provide individual blocks of time as appropriate
Leadership positions held - Local
Format - positions/total years in that office
Leadership positions held - Area
Format - positions/total years in that office
Leadership positions held - State
Format - positions/total years in that office
Leadership positions held - National
Format - positions/total years in that office
Spouse name
Format - First, Last
Spouse
Number of children
Number of grandchildren
Other significant information or accomplishments
Military service - include branch of service, years of service, and last rank
Other significant information or accomplishments
Church membership - include name of church, offices or positions held, key involvement
Other significant information or accomplishments
Civic / Community Involvement - name of organization, years of service, offices or positions held
Other significant information or accomplishments
Hobbies
Information provided by *
Name
Information provided by *
Phone number
Information provided by *
Email address
Designated contact *
Name - it is important that there is a designated contact, to answer any questions and serve as liaison to the family and to secure a family representative for the NCASWCD's Memorial Service
Designated contact *
Phone number - it is important that there is a designated contact, to answer any questions and serve as liaison to the family and to secure a family representative for the NCASWCD's Memorial Service
Representative
Name - if the family member or other individual that will participate in the Memorial Service on behalf of the deceased has been determined, please list
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