OMB
Control
No.
XXXX­
XXXX
EPA­
XXX­
X­
XX­
XXX
Approval
Expires
XX/
XX/
XX
ENERGY
STAR
®
Award
Application:
Excellence
in
Affordable
Housing
General
Instructions
Each
year,
the
US
Environmental
Protection
Agency
(
EPA)
and
the
US
Department
of
Energy
(
DOE)
honor
organizations
that
have
made
outstanding
contributions
to
protecting
the
environment
through
superior
energy
efficiency.
All
organizations
participating
in
ENERGY
STAR
are
encouraged
to
apply
for
a
2006
ENERGY
STAR
Award.
Organizations
may
apply
for
more
than
one
award
if
they
meet
the
eligibility
requirements.
In
such
cases,
a
complete
award
application
package
must
be
submitted
for
each
award.

To
be
considered,
an
organization
must
meet
the
specific
eligibility
requirements
in
the
award
application
and
submit
a
complete
application
package
by
December
15,
2005.
Winners
will
be
recognized
at
the
ENERGY
STAR
Awards
Ceremony
on
March
21,
2006
in
Washington,
DC.

Eligibility:
Excellence
in
Affordable
Housing
Governments,
non­
profits,
non­
governmental
organizations
(
NGO's)
and
other
entities
that
are
responsible
for
developing
and
administering
programs
to
develop
or
maintain
affordable
housing
and
have
incorporated
ENERGY
STAR
into
their
programs
are
eligible
to
apply.

Application
Instructions
 
Review
eligibility
for
the
award
to
which
you
are
applying
and
respond
to
all
award
criteria
specified
in
the
application
that
you
are
completing.
Do
not
exceed
the
page
limitation
specified
in
the
award
application,
as
additional
pages
will
not
be
considered.
(
Samples
and
collateral
materials
are
not
included
in
the
page
limit.)

 
Summary
of
Accomplishments:
Please
provide
a
brief
overview
(
no
more
than
300
words)
of
your
organization
and
the
accomplishments
upon
which
you
are
applying
for
this
ENERGY
STAR
award.
In
the
event
that
you
are
chosen
to
receive
an
award,
this
text
will
be
the
basis
EPA
and
DOE
will
use
in
preparing
a
summary
of
your
organization's
achievements.

 
Organization
Logo:
Please
provide
electronic
copies
of
both
color
and
a
black­
and­
white
versions
of
your
logo
in
EPS
format
that
will
allow
for
a
printable
resolution
of
300
dpi
at
a
size
of
four
(
4)
inches.
In
the
event
that
your
organization
is
chosen
for
an
award,
this
logo
will
be
used
in
the
Awards
Ceremony
materials.

 
Whenever
possible,
quantify
your
activities
and
the
results
(
e.
g.,
%
of
refrigerators
replaced
with
ENERGY
STAR­
labeled
models,
%
of
new
affordable
housing
built
to
the
ENERGY
STAR
specifications)
and
enclose
documentation
that
supports
claims
made
(
e.
g.,
copies
of
purchasing
policies
or
funding
requirements
that
incorporate
ENERGY
STAR).
 
Provide
specific
information
about
your
efforts
and
results
in
2005.
Activities
prior
to
2005
and
planned
activities
for
2006
or
beyond
are
of
interest
to
EPA
and
DOE
and
will
be
considered;
however,
they
should
not
be
the
focus
of
the
award
application.

Application
Submissions
 
For
each
award
for
which
you
are
applying,
provide:
 
one
complete
hard
copy
of
your
entire
application
package,
including
the
application
form
(
Part
I),
responses
to
award
criteria
(
Part
II),
summary
of
accomplishments,
samples,
collateral,
and
supplemental
materials,
AND
 
one
electronic
copy
(
in
Word
or
WordPerfect)
of
your
completed
application
(
Parts
I
and
II
only)
via
e­
mail
to
the
ENERGY
STAR
Awards
Coordinator,
Debra
Shepherd,
at:
shepherd.
debra@
epa.
gov.
Please
do
not
forward
supplemental
materials
via
e­
mail.

 
All
hard
copy
and
electronic
applications
must
be
date
marked/
postmarked
no
later
than
December
15,
2005.
EPA
and
DOE
will
not
accept
any
applications
or
materials
date
marked/
postmarked
after
this
date.
Due
to
the
volume
of
material
that
will
be
received,
EPA
and
DOE
will
not
be
able
to
return
any
materials
or
promotional
pieces.

 
Send
completed
applications
to
the
appropriate
address
below.
It
is
highly
recommended
that
overnight
or
two
day
delivery
be
used
to
avoid
potential
delays
and
damage
due
to
enhanced
security
screening
of
standard
mail
to
government
facilities.
Do
NOT
fax
application
packages
or
sample
materials,
as
they
will
not
be
accepted.

Via
US
Postal
Service:
Via
Overnight
Delivery
Service:
Debra
Shepherd
Debra
Shepherd
US
Environmental
Protection
Agency
US
Environmental
Protection
Agency
Ariel
Rios
Building
1310
L
Street,
NW
1200
Pennsylvania
Avenue,
NW
9th
Floor
Mail
Code
6202J
Washington,
DC
20005­
4113
Washington,
DC
20460
Phone:
(
202)
343­
9184
 
Confirmation
of
Receipt:
Upon
delivery
of
each
application,
EPA
will
confirm
receipt
to
the
e­
mail
address
from
which
the
application
was
sent.
If
you
do
not
receive
confirmation
within
two
weeks
of
sending
your
application,
please
contact
the
ENERGY
STAR
Awards
Coordinator,
Debra
Shepherd,
at
(
202)
343­
9184
or
shepherd.
debra@
epa.
gov.

 
Notification:
You
will
be
notified
by
January
31,
2006
on
the
status
of
your
application.
Part
I:
General
Information
A.
Contact
Information:
Please
provide
the
following
required
information.

________________________________________________________________________________________
Official
Name
of
Organization
or
Company
(
Exactly
as
it
should
appear
on
an
award)

________________________________________________________________________________________
Street
Address
(
Include
suite/
room
number/
mail
code)

________________________________________________________________________________________
City
State
Zip
Code
+
4
________________________________________________________________________________________
Web
Site
Address
________________________________________________________________________________________
Primary
Contact
Name
Title
E­
Mail
Address
_____________________________________
__________________________________________
Phone
(
including
area
code
and
extension)
Fax
________________________________________________________________________________________
Communications
Contact
(
including
an
authorized
advertising/
PR
firm)
Phone
________________________________________________________________________________________
Communications
Contact
E­
Mail
Address
Fax
B.
Headquarters
Address:
Please
provide
if
different
than
above.

________________________________________________________________________________________
Official
Name
of
Organization
or
Company
________________________________________________________________________________________
Street
Address
(
Include
suite/
room
number/
mail
code)

________________________________________________________________________________________
City
State
Zip
Code
+
4
C.
Certification
Statement:

"
I
certify
that
the
information
provided
in
this
application
is
true
and
accurate
to
the
best
of
my
knowledge.
I
understand
that
excerpts
from
this
application
may
be
used
by
EPA
and
DOE
for
public
outreach
related
to
the
ENERGY
STAR
program
and
2006
ENERGY
STAR
Awards."

__________________________________
______________________________
_____________
Name
Printed/
Signed
Title
Date
Part
II:
Excellence
in
Affordable
Housing
Description:
This
award
recognizes
the
work
of
organizations
that
have
made
exceptional
contributions
toward
advancing
affordable
housing
by
implementing
ENERGY
STAR
initiatives.
Governments,
non­
profits,
non­
governmental
organizations
(
NGO's)
and
other
entities
that
are
responsible
for
developing
and
administering
programs
to
develop
or
maintain
affordable
housing
and
have
incorporated
ENERGY
STAR
into
their
programs
are
eligible
to
apply.

Criteria:
Criteria
for
evaluating
this
award
are
listed
below.
Please
complete
this
application
by
addressing
each
of
the
first
two
bulleted
points
(
required)
and
any
of
the
additional
bullet
points
(
optional).
Your
total
submitted
application
should
not
exceed
two
pages
(
not
including
the
General
Information
section
and
any
supporting
materials).

Award
Evaluation
Criteria
Required:

 
Institutional
Change:
Do
your
efforts
to
utilize
ENERGY
STAR
represent
a
significant
and
lasting
change
in
your
organization's
operating
procedures
(
for
example,
through
changes
in
purchasing
policies
or
funding
requirements)?
 
Demonstrated
Success:
Have
you
demonstrated
success
in
achieving
energy
efficiency
in
affordable
housing
through
ENERGY
STAR
(
for
example,
%
of
new
affordable
housing
built
to
the
ENERGY
STAR
specifications,
%
of
refrigerators
replaced
with
ENERGY
STAR­
labeled
models,
documented
total
energy
savings
achieved)?
 
Housing
Affordability:
Does
your
project
or
do
your
projects
provide
housing
that
serves
low
and
moderate
income
families
(
for
example,
%
of
very
low­
or
lowincome
families,
or
a
mix
of
low
and
moderate
income
families,
or
a
set
aside
for
low­
moderate
income
families)?

Optional:

 
Could
your
program
inspire
successful
replication
by
other
organizations?
 
Have
you
made
efforts
to
expand
your
program?
 
Have
you
made
efforts
to
educate
occupants
about
the
energy
efficient
improvements
and
how
to
use
them?
 
Have
you
incorporated
the
ENERGY
STAR
logo
in
outreach
or
promotional
materials?

The
government
estimates
the
average
time
needed
to
review
and
fill
out
this
form
and
prepare
supplemental
materials
is
10.5
hours
and
welcomes
suggestions
for
reducing
this
level
of
effort.
Send
comments
(
referencing
OMB
Control
Number)
to
the
Director,
Collection
Strategies
Division,
U.
S.
EPA
(
2822T),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20460.
