OMB
Control
Number:
2010­
0032
Approval
Expires:
08/
31/
06
For
Review
of
Content;
Application
Will
Be
Submitted
Online
Outreach
Award
Application
SECTION
1:
COMPANY
DESCRIPTION
Please
provide
the
following
required
information:

Official
Name
of
Organization
(
as
it
should
appear
on
the
award):

Primary
Contact
Name:

Title:

E­
mail
Address:

Street
Address:

City:
State:
Zip
code:

Phone
(
area
code
+
extension):

How
did
you
hear
about
this
award?

SECTION
2:
OUTREACH
Please
describe
any
special
efforts
your
facility
has
made
to
promote
the
value
of
good
environmental
performance
and
the
value
of
participation
in
Performance
Track
(
PT)
to
the
public
and/
or
to
other
facilities.
Include
examples
of
how
your
organization
has
educated
the
public
on
the
benefits
of
PT.
Each
of
the
following
nine
categories
below
should
be
addressed.
Please
be
as
specific
as
possible.

°
Internal
Promotions
(
e.
g.
among
employees,
sister
facilities,
or
corporate
wide)
OMB
Control
Number:
2010­
0032
Approval
Expires:
08/
31/
06
For
Review
of
Content;
Application
Will
Be
Submitted
Online
°
External
Promotions
(
e.
g.
conferences,
events,
articles,
press
releases,
advertisements)

°
Assisted
PT
in
building
key
partnerships
with
states,
political
allies,
and/
or
trade
associations
(
e.
g.
held
tele­
seminar,
hosted
site
visit):

°
Number
of
new
PT
applications
resulting
from
outreach
(
list
facilities):

°
PT
Mentoring
(
e.
g.
communicated
best
practices,
assisted
with
PT
applications):

°
Served
as
PT
event
host
(
e.
g.
program
acceptance
event,
conference,
awards
ceremony,
application
workshop,
member
event):

°
PT
Logo
Use
(
e.
g.
media
materials,
flag
use,
stickers,
vehicle
signs):

°
PT
mentioned
on
facility's
website
(
e.
g.
facility
and/
or
corporate,
list
URL):
For
Review
of
Content;
Application
Will
Be
Submitted
Online
°
Other:

Award
Description:
This
coveted
award
recognizes
current
EPA
Performance
Track
members
who,
in
addition
to
being
exemplary
environmental
stewards,
make
a
special
effort
to
inform
the
public
about
what
it
means
to
be
a
member
of
the
Performance
Track
(
PT)
program
.
The
award
also
recognizes
members'
efforts
to
reach
out
to
and
encourage
other
U.
S.
facilities
to
join
Performance
Track.
A
win­
win
relationship
is
created
as
more
facilities
come
forward
and
commit
to
continuous
environmental
improvement.
Through
the
Outreach
Award,
we
seek
to
show
our
appreciation
to
members
who
continually
work
to
strengthen
Performance
Track.

The
Performance
Track
Outreach
Award
is
sponsored
by
the
U.
S.
Environmental
Protection
Agency's
Performance
Track
Program.

Eligibility:
All
current
members
of
the
Performance
Track
Program
are
eligible
to
apply
for
this
award.
Facilities
may
self­
nominate,
be
nominated
by
other
facilities,
states
or
local
entities,
or
by
EPA
Performance
Track
staff.
Completed
applications
must
be
received
by
December
15
of
the
applicable
calendar
year.
(
e.
g.
for
activities
occurring
in
the
'
04
calendar
year,
applications
are
due
on
December
15,
2004)

Application
Process:
The
application
period
is
based
on
calendar
year
activities
by
a
facility,
with
applications
due
December
15
of
the
applicable
year.

Notification
and
Presentation:
Recipients
will
be
notified
via
telephone
and
a
letter
from
the
Performance
Track
Director.
Awards
will
be
presented
at
the
Annual
Member
Event
and
Conference.

For
more
information:
Please
contact
Luctrician
Booth
at
booth.
luctrician@
epa.
gov
or
call
(
202)
566­
2867.

The
public
reporting
and
record
keeping
burden
for
this
collection
of
information
is
estimated
to
average
1.5
hours
per
response.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number.
To
comment
on
this
collection
contact
the
Director,
Collection
Strategies
Division
(
2822T),
1200
Pennsylvania
Ave.
NW,
Washington,
DC
20460.
Include
the
OMB
control
number
in
any
correspondence.
Do
not
send
the
completed
form
to
this
address.
