6100-17 Awards Application Form - Irrigation

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Section 1: General Information

Irrigation - Awards Application

Please fill out and submit this form electronically to WaterSense by Monday, April 1, 2013. If you have any questions,
please refer to the Frequently Asked Questions page or email the WaterSense Helpline.
To save a draft of this application, select “Save my progress and resume later”. You will be prompted to provide an email
address and password that you will use to re-enter the form. WaterSense does not have access to these passwords,
so please keep your password in a safe place.
Please fill in the following information as it relates to your organization:

Irrigation Partner Name * Please select...
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WaterSense Labeled Certification(s) (Select all that apply) *
Please select...
Certified Golf Irrigation Auditor (Irrigation Association)
Certified Irrigation Contractor (Irrigation Association)
Certified Irrigation Designer (Irrigation Association)

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To select multiple options, hold Ctrl or



Command key and select with mouse.
Title
Company/Organization
Phone *
Fax
Email *

Format (xxx xxx xxxx)

Section 2: Eligibility
Please verify your eligibility: * 
 Yes, I became a WaterSense partner prior to January 1, 2013. 
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

 Yes, by



checking this box I confirm that at least one of my WaterSense labeled certifications is current.

Section 3: Landscape Irrigation Work Description
Briefly describe, in no more than 300 words, the type of landscape irrigation you do (e.g.,
design/install/maintenance/audit, commercial vs. residential). If selected to receive an award, this
description may be used in recognition materials. *
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Section 4: Written Statement
If you haven’t done so already, please download, complete, and save your written statement.

Please upload your final written statement, in which you have addressed the evaluation criteria. *
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Acceptable file formats: Word or PDF.

Section 5: Supporting Materials
Please note: WaterSense is no longer accepting hard copy supporting materials. Partners are also asked to limit their
electronic supporting materials to 25 pages. Additional supporting materials will not be reviewed.

Please upload any supporting materials that help demonstrate the accomplishments described in your

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Irrigation - Award Application

written statement. Including supporting materials is not required, but is strongly encouraged. To upload
additional supporting materials, please use the "Upload more supporting materials" link below the first
record.
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Upload more supplemental materials
Please note: Individual files may not exceed 5 MB. Total file size may not exceed 20 MB.
We understand that some high-resolution photos may be quite large and push your application over the 20 MB file size
limit. Therefore, you may send up to 10 additional photos of your 2012 WaterSense-related activities to
[email protected]. These photos may be used in recognition materials if your organization is selected for an
award. Materials other than photos sent to this email address will not be reviewed with your application.
Your application form, including the written statement and supporting materials, must be submitted by Monday, April 1,
2013 to be considered for an award.
On the following page, you will be asked to review your responses. You must select "confirm" at the bottom of the
following page to submit your award application to WaterSense.
Please note, you may need to try different printer settings or print as a PDF to print the full report for your records. We
apologize for any inconvenience.
Need assistance with this form?

OMB Control Number 2040-0272
Approval Expires 06/30/2013
EPA Form Number 6100-17. The public reporting and record keeping burden for this collection of
information is estimated to average 25 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 Avenue, NW,
Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed
form to this address.