Form 5900-578 President's Environmental Youth Award

OMB Control Number: 2090-0031
Expiration Date: 4/30/22

Section 1: Program History
The President’s Environmental Youth Awards (PEYA) recognizes outstanding environmental
projects by K-12 youth. PEYA promotes awareness of our nation’s natural resources and
encourage positive community involvement. Each year the PEYA program honors a wide variety
of projects developed by young individuals, school classes (kindergarten through high school),
summer camps, public interest groups, and youth organizations to promote environmental
awareness.
Past projects have achieved demonstrated impact in schools and communities - including
building nature trails, starting recycling programs, restoring native habitats, installing renewable
energy projects. To read about past award-winning projects, visit:
https://www.epa.gov/education/presidents-environmental-youth-award-peya-winners

Section 2: How the Program Works
The U.S. Environmental Protection Agency (EPA) has ten regional offices across the country.
Each regional office will be responsible for selecting up to two winners per region, based on the
evaluation criteria in Section 6. Applicants are welcome to include youth across multiple grade
levels; however, the application will be categorized based on the applicant with the highest-grade
level. For example, if one applicant group consists of two 4th graders, one 3rd grader and one 6th
grader, the application will be evaluated in the Grade 6-12 category.
Each award-winning project will receive a Presidential plaque. All qualified applicants will
receive recognition from EPA leadership honoring them for their efforts to protect human health
and the environment.

Section 3: Program Eligibility
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Project is completed while the applicant(s) is in kindergarten through 12th grade.
Applicant(s) is a citizen of the United States or its territories or has been lawfully
admitted for permanent residency. Applicant also resides in a U.S. state or territory.
Project is sponsored by at least one adult over the age of 21.
Projects started on or after January 1, 2020 and with activity during the 2020 calendar
year are eligible for consideration. As long as there was activity on the project during the
2020 calendar year, a project initiated prior 2020 or that has continued activity in 2021 is
eligible for consideration.
Projects must include an environmental stewardship component as defined below.

BURDEN STATEMENT
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2090-0031. Responses to this
collection of information are voluntary (20 U.S.C. § 5507(d)). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated
to be approximately one hour 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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.
EPA Form: 5900-578

Section 4: Project Sponsors
Each applicant or group of applicants applying for PEYA should be represented by at least one
sponsor who is a teacher or other education professional and who can certify that the project
was performed by the applicant(s). An applicant may also have a co-sponsor, who is typically
another teacher or education professional who can certify the project or is often someone in the
community or a subject matter expert who has provided guidance on the project. For homeschooled applicants with no interaction with formal educators, the teacher sponsor can be a
parent. The sponsor/co-sponsor must be an adult at least 21 years of age. The sponsor/cosponsor must sign and date the application.
The adult sponsor plays an important role in helping a young person or group of young people
carry out a project and apply for PEYA. Typically, a sponsor/co-sponsor offers suggestions
and advice throughout the project to: develop a well-thought-out project; implement the project;
work with other groups and individuals in the community; complete the application form (for
K-5 applicants); and assist in preparing accompanying materials.

Application Validation
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By signing, both the teacher and sponsor/co-sponsor(s) certify that the applicant(s) has
performed this project.
The teacher is responsible for receiving PEYA awards for non-attending winners at school
location.
The teacher is responsible for coordinating with the sponsor and co-sponsor to distribute the
awards and certificates.
The teacher and sponsor/co-sponsor(s) confirm receipt of a signed Consent for PEYA Student
Works form and a signed PEYA Permission Slip from the parent or guardian of the applicant(s)

Questions about teacher or sponsor/co-sponsor's role should be directed to [email protected].

Section 5: How to Apply
A blank application is provided on page A-1. A PDF version of this document can be viewed or
downloaded at:
https://www.epa.gov/education/presidents-environmental-youth-award-peya-application

Application Requirements
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A project summary of up to 300 words must be provided on the application form. A more
detailed description of the project, no more than five pages, and addressing each of the
evaluation criterion should be attached to the application.
Applicants that are applying in the 6-12 grade level category must complete the project
summary section themselves as well as the project description. Applicants in the K-5
grade level may be advised by the sponsor /co-sponsors and may assist in the writing of
the project summary and description.
Applicants may submit up to five additional pages of supporting materials: photographs,
newspaper articles, or other information to provide a more comprehensive view of the
project. Accompanying videos must be web-based. Do not email video files or mail CDs.
Each applicant or team of applicants applying for PEYA must be represented preferably
by a teacher sponsor or educational professional. Sponsors/co-sponsor must sign and
date page A-3 of the application. Signatures can be electronic or ink-on-paper but not
simply the sponsor name typed in.
All application materials must be received by April 30, 2021. See instructions below for
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submitting an application.

Consent for PEYA Student Works form and PEYA Permission Slip
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Two forms found at the end of this application, the Consent for PEYA Student Works
form and PEYA Permission Slip, must be signed by the parents or legal guardian of each
applicant and included with the application materials submitted unless the student is 18
years of age or older at the time of application.
Please contact us at [email protected] to obtain an alternate PEYA Student Works form
that is signed by students age 18 years of age or older at the time of application.
Prior to signing the PEYA Permission Slip, parents and guardians should review EPA's
privacy policy found at the end of this application and at:
https://www.epa.gov/sites/production/files/2013-11/documents/2182g.pdf
For privacy purposes, EPA will not use the last names of children in the award ceremony
speeches, in press releases, or on its website. We will share the video and photographs
with teacher and sponsor/co-sponsors after the event along with any press releases.

Application Submission
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To protect the online privacy of student applicants, application materials should be
submitted by applicant sponsors / co-sponsors.
For this year’s competition, applicants are strongly encouraged to submit all application
materials electronically (email). If you plan to mail some or all of your application
materials, please contact us at [email protected] so that we can ensure receipt.
Email completed application materials to [email protected] by 11:59 p.m. ET on April
30, 2021. Applicants are encouraged to provide application materials via a single email,
with attachments preferably in PDF or MS Word. To ensure receipt please also contact
us if you have a ZIP file or file attachments over 20MB.
Mailed applications must be received by April 30, 2021, at the address below to be
eligible for consideration:
U.S. Environmental Protection Agency
Office of Environmental Education
ATTN: President’s Environmental Youth Award Program
William Jefferson Clinton North, Room 1426
1200 Pennsylvania Ave, NW, MC 1704-A
Washington, DC 20460
A confirmation email is sent upon receipt of the application. Ongoing Correspondence
regarding the application is with the sponsor/co-sponsor named in the application.

Frequently Asked Questions
A list of frequently asked questions can be found at
https://www.epa.gov/education/presidents-environmental-youth-award#questions
Additional questions should be directed to [email protected].

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Section 6: How Applications Are Judged
Each application is evaluated by a regional awards panel. The panel members review and evaluate
each application based on the criteria below. There are separate evaluation criteria for K-5 and
6-12 applications. A maximum of 100 points can be awarded to each application

Evaluation Criteria K-5 (100 points)
Youth Initiative (15 points)
How did the applicant(s) come up with the idea for the project? To what extent does the
applicant(s) take charge of the project?
Environmental Stewardship* and Impact (30 points)
Was there an environmental stewardship component to the project? How did the
applicant(s) identify the environmental need for this project? How did the
project positively affect the environment? Did the applicant(s) complete the
project?
Achieving Competition Goals (15 points)
Winning projects may highlight environmental stewardship in a variety of areas, including
the following: climate change; environmental sustainability; a healthy school environment,
including projects that reduce food waste in school cafeterias; environmentally friendly
agriculture practices; reducing and preventing human contributions to ocean litter; school
gardens; recycling; or using STEM to teach environmental education.
How did the project address one of the focus areas of the competition including: climate
change; projects that reduce food waste in school cafeterias; environmentally friendly
agriculture practices; reducing and preventing human contributions to ocean litter; school
gardens; recycling; or using STEM to teach environmental education?
Community Involvement (15 points)
To what extent did the project involve others in the school or community? Please
describe the community.
Project Creativity and/or Innovation (15 points)
What creative and/or innovative approach(es) did the applicant(s) use for the project?
Project Approach (10 points)
To what extent does the application tell a complete story about the project? Did the
applicant(s) have a thought-out approach to solving the problem?
*Definition: “Environmental or Conservation Stewardship” is voluntary commitment, behavior,
and action that results in environmental protection or improvement, or conservation of our
natural resources. Stewardship refers to an acceptance of personal responsibility for actions to
improve environmental quality and to achieve conservation outcomes. Stewardship involves
lifestyles and business practices, initiatives and actions that enhance the state of the environment
and natural resources. Some examples are: living or conducting business in such a way as to
minimize or eliminate pollution at its source; using natural resources efficiently; decreasing the
use of hazardous chemicals; recycling wastes effectively; and conserving or restoring soil,
forests, prairies, wetlands, rivers, and parks. Stewardship can be practiced by individuals, groups,
schools, organizations, companies, communities, and state and local governments.
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Evaluation Criteria 6-12 (100 points)
Youth Initiative (15 points)
To what extent was the project designed, coordinated and implemented due to
applicant(s) initiative? How was the project created and completed by the applicant(s)?
The driving force for the project must be the applicant(s), not the sponsor/co-sponsor.
Environmental Need and Appropriateness (20 points)
To what extent was there a clear environmental need for the project? How appropriate
was the project for the community in which it was performed?
Environmental Stewardship* and Impact (15 points)
Was there an environmental stewardship component to the project? How did the project
positively affect the community? Were there any long-term environmental benefits or
outcomes of the project? Did applicant(s) complete the project?
Achieving Competition Goals (15 points)
Winning projects may highlight environmental stewardship in a variety of areas, including the
following: climate change; environmental sustainability; a healthy school environment,
including projects that reduce food waste in school cafeterias; environmentally friendly
agriculture practices; reducing and preventing human contributions to ocean litter; school
gardens; recycling; or using STEM to teach environmental education.
How did the project address one of the focus areas of the competition including: climate
change; projects that reduce food waste in school cafeterias; environmentally friendly
agriculture practices; reducing and preventing human contributions to ocean litter; school
gardens; recycling; or using STEM to teach environmental education?
Community Involvement (15 points)
To what extent did the project positively involve others in the community? Please
describe the community. What community resources, expertise, leadership, or publicity
did the applicant(s) use?
Project Creativity and Innovation (10 points)
How did the applicant(s) use innovative approaches to achieve positive results?
Soundness of Approach, Rationale, and Scientific Design (10 points)
Was the approach to the problem clear? Did the applicant(s) have a sound justification for
choosing that approach? If so, what is that justification?
*Definition: “Environmental or Conservation Stewardship” is voluntary commitment, behavior,
and action that results in environmental protection or improvement, or conservation of our
natural resources. Stewardship refers to an acceptance of personal responsibility for actions to
improve environmental quality and to achieve conservation outcomes. Stewardship involves
lifestyles and business practices, initiatives and actions that enhance the state of the environment
and natural resources. Some examples are: living or conducting business in such a way as to
minimize or eliminate pollution at its source; using natural resources efficiently; decreasing the
use of hazardous chemicals; recycling wastes effectively; and conserving or restoring soil,
forests, prairies, wetlands, rivers, and parks. Stewardship can be practiced by individuals, groups,
schools, organizations, companies, communities, and state and local governments.
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Individual Application
Full Name

Project Title
Project Location:
(project city, state/territory,
ZIP code and school name)
Project Start Date
Project End Date (if applicable)
OR

Team Application
Team Name

Project Title
Project Location:
(project city, state/territory,
ZIP code and school name)
Total Number of Applicants
Project Start Date
Project End Date (if applicable)
Please check the box below for the applicable grade level category:
☐ K-5
☐ 6-12

Did the project receive press coverage? If yes, please attach press clippings.
☐ Yes
☐ No

Applicant Grade Level(s):
Complete the table below with information for each of the applicant(s). Each applicant u n d e r 1 8 a t
t i m e o f a p p l i c a t i o n must have a signed Consent for PEYA Student Works form and a signed PEYA
Permission Slip from their parent or guardian. Large teams can appoint a representative. Please contact us at
[email protected] for alternate forms signed by students age 18 or older at time of application.

Grade

Full Name

President’s Environmental Youth Award Application

Revised February 2021

A-1

Full Name

Grade

Teacher
Teachers provide work associated information ONLY and provide address for mailing awards and
certificates. For home-schooled applicants with no interaction with formal educators, the teacher-sponsor
can be a parent and provide work or personal contact information. The teacher (or parent of home-schooled
applicant) and sponsor / co-sponsor (if applicable) must sign and date page A-3 of the application.

Full Name
School Name/Street Address/
City/State or Territory/ZIP:
Relationship to Applicant(s)

☐ Sponsor

☐ Co-sponsor

Work Phone Number
Work Email

Sponsor/Co-sponsor (if applicable)
Full Name
Relationship to Applicant(s)

☐ Sponsor

☐ Co-sponsor

Phone Number
Email

President’s Environmental Youth Award Application

Revised February 2021

A-2

Description of the Project
Please provide a brief project summary (of up to 300 words in Times Roman 12pt font) of the project
in the space provided below describing the project's purpose and goals and identifying the results
achieved. No hand-written project summaries, and please do not include student(s) last name(s).

A more detailed description of the project, addressing the evaluation criteria, should be included separately in
3-5 pages, double-spaced, Times New Roman, font size 12. No hand-written project descriptions, and please do
not include student(s) last name(s). You may also include up to 5 additional pages of photographs, press
clippings, and other supporting materials.
By signing below, the teacher and sponsor/co-sponsor(s) certify that the applicant(s) has
performed this project. The teacher and sponsor/co-sponsor(s) also confirm receipt of a signed Consent
for PEYA Student Works form and a signed PEYA Permission Slip from the parent or guardian of the
applicant(s). If needed, please refer to these instructions for e-signing a PDF in Adobe Acrobat Reader.

Date:
Teacher Signature
Date:
Sponsor / Co-sponsor Signature
President’s Environmental Youth Award Application

Revised February 2021

A-3

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460

PEYA Permission Slip
Dear Parent / Guardian:
Your child is applying to participate in the President's Environmental Education Youth Award (PEYA) program. Because thisU.S. Environmental
Protection Agency (EPA) program includes features that require us to collect personal information from your child, we are contacting you to obtain
your consent so that your child may participate in the program, as described below.
Please read EPA's privacy policy, which can be found at (https://www.epa.gov/sites/production/files/2013-11/
documents/2182g.pdf) and attached to this form. If this privacy policy and the terms represented below are acceptable to you, please provide your
consent by signing this form. Signed forms should be returned to the teacher or project sponsor / co-sponsor helping to complete your child's PEYA
application.
The PEYA program requires parental/legal guardian consent from all minors under the age of 18 seeking to participate in the program. This form
also satisfies requirements of the Children’s Online Privacy Protect Act (COPPA), under which the owners of certain types of websites and online
services must obtain “verifiable parental consent” before collecting, using or disclosing personal information from children under the age of 13.
With your signature below, you hereby attest to the following:

1.

I am 18 years of age or older and the parent/legal guardian of

2.

I have read the EPA privacy policy, linked above, and consent to my Child’s participation in the PEYA program.

(my Child).

3.
In connection with the PEYA program, I also consent to EPA’s disclosure of my Child’s first and last name, the name of their
school (city and state), the name of their project and their grade level.
4.
I further consent to the potential disclosure of this information on EPA’s social media and/or webpages to promote my child’s
environmental project. I understand that EPA employees administrating the PEYA program will potentially use this information
to promote participating students, such as my Child, and their environmental projects through national and regional press releases, EPAproduced videos, EPA’s official website, printed PEYA program awards booklets, and EPA social media pages displayed on online
platforms such as Facebook, Youtube, and Twitter.
5.
I understand that EPA employees may also use my Child’s personal information to connect my Child to other children
participating in the program through an online community featuring past PEYA winners (e.g., via Facebook groups, LinkedIn).
6.
I understand that EPA videotapes and photographs the PEYA ceremony. EPA intends the video and photographs to be used for
informational, educational, and/or public relations purposes both within the EPA and by the general public. I understand
the video and photographs from the ceremony may feature my Child’s image and/or voice and may appear online as soon as 30 minutes
after the taping. I understand the video and/or photographs will remain online indefinitely and may subsequently appear in
EPA hard copy publications or other non-EPA publications that EPA deems appropriate to help promote or publicize the event or purpose
for which the video, photo(s) and/or voice recording was prepared.
7.

I authorize disclosure and release of the video, photo(s) and/or voice recording to EPA.

8.
I have read and understand the foregoing and I consent to the use of my Child’s video, photo(s) and/or voice recording as
specified for the above-described purpose(s). I further understand that no royalty, fee or other compensation of any character shall become
payable to me or my custodian by EPA for such use. I understand that consent to use my Child’s video, photo(s) and/or voice recording
is voluntary.
9.
In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein mine or that of
my Child’s video likeness appears.
10.

I hereby hold harmless and release and forever discharge the United States and EPA from all claims, demands, and causes of action
which I and/or my Child, heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate
or that of my custodian have or may have by reason of this authorization.

11.

As the legal guardian/custodian of my Child, I am competent to contract in my own name and/or in the name of my Child. I have
read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Parent / Guardian Signature

Parent / Guardian Printed Full Name

Date