U.S. EPA MONTREAL PROTOCOL AWARDS NOMINATION FORM



Introduction

The Stratospheric Protection Division of the U.S. Environmental
Protection Agency (EPA) invites nominations for the U.S. EPA Montreal
Protocol Awards. This award program was established in 1990 to recognize
outstanding contributions to the protection of the Earth’s
stratospheric ozone layer.

Background & Organization 

Since 1990, over 500 awards have been presented to outstanding
individuals and teams, dedicated companies, forward-thinking
organizations, and visionary government institutions from 54 countries.
Awards are particularly prestigious because nominees compete globally
against the accomplishments of many other potential awardees, and
recipients are selected by previous awardees and EPA.

EPA seeks nominations for the following accomplishments: originality and
public purpose; leadership and corporate responsibility; global
perspective and implication; actual elimination of ozone-depleting
substance emissions; success in eliminating substances that deplete the
ozone layer and contribute to climate change or in transitioning to
alternatives with reduced environmental impact; or leadership in
improving awareness of the harmful health effects of overexposure to UV
radiation. Award recipients are leading by example. Their demonstrated
commitment and extraordinary contributions inspire other individuals and
organizations to make a difference in protecting the environment and
public health. Their significant contributions help mitigate the health
and environmental risks of ozone depletion, which include skin cancer,
suppression of the immune system, cataracts, and damage to marine life
and crops, as well as the health and environmental risks of climate
change, which include air quality problems and damage to agricultural
crops.

Awards Panel & Selection of Award Recipients 

EPA’s Stratospheric Ozone Protection Program consults an international
panel of judges about the nominations. The judges represent government,
industry, and non-governmental organizations.  EPA makes the final
selections.

Instructions

All nominations must include an official cover letter from the
nominator, a completed application form, and a one-page summary of
accomplishments. Electronic submissions are preferred. Because the
judges will not be able to conduct on-site visits, applicants are
encouraged to submit supporting materials such as photographs, videos,
technical descriptions, news clippings, and press releases. Please note
that all submissions are final, and the application and supporting
materials will not be returned.

Nominations must be mailed, faxed or e-mailed no later than December 31.
 

E-Mail (preferred): Vazquez.Kristinn@epa.gov

Regular Mail:

U.S. EPA Montreal Protocol Awards

Attn: Kristinn Vazquez

U.S. Environmental Protection Agency

1200 Pennsylvania Ave. NW (6205J)

Washington, D.C. 20460, USA

Express Delivery (FedEx, UPS, DHL, etc.)

U.S. EPA Montreal Protocol Awards

Attn: Kristinn Vazquez

Stratospheric Protection Division

1310 L Street, NW, Room 1032

Washington, D.C. 20005, USA

Questions?

For more information, visit:   HYPERLINK
"http://www.epa.gov/ozone/awards/"  www.epa.gov/ozone/awards/ 

or contact Kristinn Vazquez at 1 (202) 343-9062 or by e-mail at
Vazquez.Kristinn@epa.govThe public reporting and recordkeeping burden
for this collection of information is estimated to average 2.5 hours per
response.  Send comments on the Agency's need for this information, the
accuracy of the provided burden estimates, and any suggested methods for
minimizing respondent burden, including through the use of automated
collection techniques to the Director, Collection Strategies Division,
U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave.,
NW, Washington, D.C. 20460.  Include the OMB control number in any
correspondence.  Do not send the completed form to this address.

U.S. Environmental protection agency montreal protocol Award nOMINATION

Award Category

  FORMCHECKBOX   Individual  	  FORMCHECKBOX  
Organization/Association/Group  	  FORMCHECKBOX   Corporate 	 
FORMCHECKBOX   Government	  FORMCHECKBOX   Team

Title of project or activity

(if applicable)

	Approximate date project began

(if applicable)

	Project status:

(if applicable)	  FORMCHECKBOX   Ongoing	  FORMCHECKBOX   Complete



Information about the nominee

Name of award nominee

(primary contact; include other names and info as well) 

	Address	(if company or organization, use headquarters address)

City

State/

Province

ZIP/Postal Code

	Country 

	Phone

E-mail 

	Contact (if nominee is an organization)

	Contact phone

Contact

e-mail

	

information about nominator

Nominated by: 

Affiliation

	Address

	City

State/

Province

ZIP/Postal

Code

	Country

	Phone

E-mail 

	

References 

Please identify two independent experts who can verify the
accomplishment(s) of the person or organization nominated for the award.

Name

Affiliation

	E-mail

Phone

	Address

	Name

Affiliation

	E-mail

Phone

	Address

	

Summary of Accomplishments



Please summarize the nominee’s accomplishment in the space below, or
attach a one-page summary (no longer than 600 words).



Signature of Nominator

I certify that my answers are true and complete to the best of my
knowledge.

Signature

Date

	Please note- no signature necessary if form sent electronically from
nominator’s e-mail account.





Eligibility

Candidates may be from anywhere in the world.	

Individuals and organizations may work for the public or private sector.

Candidates may be either self-nominated or nominated by a third party.

nOMINATION Process

Nominations should include a standard nomination form, a cover letter
from the nominating individual/organization, a one-page summary of the
candidate’s accomplishments, and supporting materials.

			

Selection Criteria

Award recipients must demonstrate one or more of the following criteria:


originality and public purpose; 

leadership and corporate responsibility; 

global perspective and implication; 

success in eliminating substances that deplete the ozone layer and
contribute to climate change or in transitioning to alternatives with
reduced environmental impact; or

leadership in improving awareness of the harmful health effects of
overexposure to UV radiation. 

Actual (as opposed to anticipated) results/reductions are preferred. 

Judging Process

Nominations will be screened by a panel of judges selected for their
expertise.  Past awardees also serve on the judging panel.  EPA makes
the final selection of award recipients.

 

Presentation of Awards

Award recipients will be announced at the annual Awards Ceremony in the
fall at a location to be determined.

Recipient Benefits

Past recipients of the Award have noted their appreciation of the
benefits that accompany this award. Those selected can expect to enjoy:
the honor of receiving this prestigious, international environmental
award; increased name recognition; improved employee morale; and
personal satisfaction and affirmation of having made a real difference.

	OMB Control Number: 2060-NEW

Expiration Date: 6/30/13

EPA Form # xxxx-xxx, Revised 06/10

