Western Pennsylvania Environmental Awards

Please read all instructions prior to completing this form.

You may not save your work here and submit later. You should draft your answers to the narrative portion in a Word or text document and then upload that document here. Your nomination for the narrative portion is limited to the equivalent of four (4) one-sided, double-spaced 8 1/2 x 11" pages.

If you are nominating another organization for this award, please list BOTH the contact information of the person submitting the form (Nominator) and a contact who represents the organization being nominated (Nominee).

Please click "Submit" at the bottom of the page only when your application is complete. By clicking "submit" you confirm that the information on the application is accurate and complete to the best of your knowledge and belief.

You will receive a confirmation email when your nomination has been submitted.

Nominee: *

Exact name of organization, company, department, program, individual, etc. being nominated, as you would want it presented on printed materials and/or awards

Nominee Contact Name: *

Please list a person representing the nominee's organization

Nominee Address:

of contact person

Nominee Phone:

Nominee Fax:

Nominee Email:

Nominator Contact Name:

Please list the contact information for the person sumbitting this nomination (if different from the nominee)

Nominator Address:

Nominator Phone:

Nominator Email:

Environmental fines or citations?:

YES

To your knowledge, has the nominee or nominee's organization or company been fined or cited for adverse environmental impact at any time during the past three years.

If YES, please explain briefly:

What environmental need within the community or organization did the nominee address?:

What kind of solution did the nominee develop to address the identified need?:

Describe any unique or innovative aspects of the initiative, particularly any special challenges overcome as part of the implementation and/or outstanding creativity involved.

What effect or impact did the nominee have on the environment?:

(Base your answer on environmental benefits related to community awareness, environmental quality, the local economy, public policy, technical contributions, etc.). Include in your response the scope or breadth of this impact within the community or organization.

What specific examples, data or other evidence demonstrate the environmental effect or impact described above?:

What other pertinent information about this nominee would you like the judges to consider?:

Letter of support:

All nominations must be accompanied by one (1) letter of support from someone outside the nominee's organization who is familiar with the success of the nominated activity; this letter must be written by someone other than the nominator. The letter should explain the impact of the nomination, its environmental significance or benefit, and its relevance in meeting a specific need.

Western Pennsylvania Environmental Awards

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