Form 6200-07 NPEP Champion Enrollment Form

ENROLL US

We Want to Be a Champion for EPA’s National Partnership for Environmental Priorities (NPEP)

For instructions or more information on NPEP Champion program, visit epa.gov/npep

CHAMPION AGREEMENT

Our organization is choosing to become a Champion for EPA's National Partnership for Environmental Priorities. Our goal is to recruit one or more partners that will reduce the quantity of one or more priority chemicals currently found in their products, processes, or releases using techniques such as source reduction, recycling, or other materials management practices. In this enrollment application, we identify two or more voluntary goals to promote reduction of priority chemicals and recruit new partners that we believe we can achieve as champions in this program. The voluntary goal(s) provided below is an initial estimate and may change over time. We may revise our goal(s) or withdraw from the program at any time. If/when we choose to revise our goals or withdraw from the program, we will notify EPA.

IDENTIFYING INFORMATION

Name of Organization: Facility Name:                                                                              Principal Contact: Title:                                                                              

Authorizing Official: Title:                                                                               Address: City/State/Zip:                                                                              Phone/Fax: Email:                                                                            

EPA RCRA ID Number: Date:                                                                                             

Note: In order to qualify as an NPEP Champion, you must in Goal 1 commit to recruit or assist in recruiting a partner for NPEP. You must also have a goal, chosen from the list in Goal 2 below.

To accomplish this goal, we will use the following options (check all that apply):

GOAL #1

___Initiate a campaign to recruit new partners

___work independently

___work with Regions

Narrative description of proposed project (please include projected timeline in your description):                                                                                                                                              

How we will measure success:                                                                                                                                                                    

 

GOAL #2

___Our Corporate Website

___Link to EPA’s website and/or

___maintain info about NPEP on website

___Feature NPEP in publications

___Technical Assistance

___Create outreach materials promoting NPEP

___ Other (please describe)

___Distribute NPEP outreach materials

___At conferences

___At events

___On website

___Include NPEP in presentations

___At conferences

___At events

Narrative description of proposed project (please include projected timeline in your description):                                                                                                                                              

How we will measure success:                                                                                                                                                                     

Once these goals have been accomplished, please submit a success story (following outline provided at www.epa.gov/npep). At this point you will qualify for an NPEP Champion Award and the chance to become NPEP Champion of the Year