2 0 1 2 Western Pennsylvania Environmental Awards Nomination Cover Sheet Instructions Please Read Carefully The Awards are open to any group, individual, program, company, school or organization located and working in one of the following counties: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland. Online submissions are encouraged, but nominations through mail will be accepted. When submitting via postal service, a copy of the nomination cover sheet must be included with the application. Each nomination is limited to four (4) typed, one-sided, double-spaced, 81⁄2” x 11” pages, and must provide responses to the following five questions. Please include the question with your responses. 1. What environmental need within the community or organization did the nominee address? 2. 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. 3. 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. 4. What specific examples, data, or other evidence demonstrates the environmental effect or impact described above? 5. What other pertinent information about this nominee would you like the judges to consider? In addition, 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; someone other than the nominator must write this letter. This letter should explain the impact of the nomination, its environmental significance or benefit, and its relevance in meeting a specific need. Please include contact information for nominator and nominee if different. Include both phone number and e-mail if available. No photos or supporting materials will be considered in the judging process. Please submit completed nominations by March 5, 2012. Nominations received after this date will not be considered. Nominations may be submitted online at www.pecpa.org/wpea, or by completing this form and sending to the address below. Online submissions will receive a confirmation e-mail that the entry has been processed. If you do not receive a confirmation email within 24 hours, please call 412-481-9400. Mailed entries should be submitted to: Pennsylvania Environmental Council 2012 Western PA Environmental Awards Program 22 Terminal Way Pittsburgh, PA 15219 Nominations may be made by the person or persons involved in the activity, or by a third party. Each Western Pennsylvania Environmental Award winner will receive: • $5,000 cash award designated to the nonprofit organization of their choice • Custom-framed commemorative photograph • Two complimentary tickets to the Western Pennsylvania Environmental Awards Dinner on June 28, 2012 • Media recognition of your program and award • Commemorative poster of your winning project • Recognition and a full description of your winning project in the Awards Dinner program The Pennsylvania Environmental Council and Dominion have the right to review and deny any application that is not appropriate or that does not meet the nomination requirements. Employees, their immediate families, and programs of the Pennsylvania Environmental Council and Dominion are not eligible. If you have any questions about the nomination process, please call the Pennsylvania Environmental Council at 412-481-9400 or e-mail [email protected]. Nomination Cover Sheet Please Read Carefully Nominee Information Nominator Information I would like to nominate the following organization, company, department, program, individual for a Western Pennsylvania Environmental Award. (Person submitting the nomination — if different from left.) Nominee Name (Exact name of organization, company, department, program, individual, etc. being nominated, as you would want it to be presented on printed materials and/or awards.) Title Organization Contact name (Name of person representing nominee above.) Address Address City (of contact name above) State Zip City Phone State Zip Fax Phone E-mail Fax Relationship to Nominee E-mail (ie. board member, volunteer, staff, friend...) County(ies) served Please provide a 50 word description of the nomination I confirm that the above information is accurate and complete to the best of my knowledge and belief. Nominator Signature Only finalists (both nominee and nominator) will be notified in April 2012 at which time arrangements will be made for a site visit if appropriate. Winners will be honored at the Environmental Awards Program and Dinner in Pittsburgh. Sponsored By Date