Form 5900-xxx Application

2015 Green Power Leadership Awards

Application Instructions: U.S. EPA Partnership Categories

1. Ensure Eligibility

An applicant or organization nominated for an award by a third-party is eligible if the following requirements are met:

• Is an EPA Green Power Partner and will maintain partner status through the awards event.

• Applicants that are not EPA Green Power Partners must join the Partnership by April 17, 2015.

• Only eligible green power generated from U.S.-based renewable energy resources will be considered. Please review the Partnership Requirements (PDF) (16 pp, 2MB) for more information.

• Applicants must have an operational on-site green power generator or have completed a green power purchase by April 17, 2015. The green power purchase is considered complete when delivery is executed.

• Previous winners and applicants are eligible.

• Only U.S.-based operations and facilities are eligible.

• Applicants or nominees will be evaluated on the green power use they have reported to the Green Power Partnership as of April 17, 2015.

• Please note: Eligibility will be verified during the review process, and finalists will need to pass an EPA compliance screen in order to be selected.

2. Complete Application Form

Please submit one application form for each organization¹. Organizations should submit only one application form, even if they are applying for multiple award categories. Third-parties may nominate more than one organization for an award, but must use a separate application for each nominee.

Organizations are encouraged to apply directly. If you are a third-party nominating an organization for an award, the organization you are nominating MUST be copied on the email submittal and we advise you to consult with them to accurately capture their full contribution to the green power marketplace, not just your experience with them. Please complete all sections of the form:

Award Categories

Contact Information

Eligibility Questions

Green Power Use Questions & Data Form

Essay Questions

Communications Activities

3. Submit Supplemental Materials (encouraged but not required)

• If possible, please provide all supplemental materials supporting communications claims in one (1) PDF file. Please be sure to label all supplemental materials with the organization’s name in the filename. Note that materials may be emailed to [email protected] if less than 10 MB in size. If larger, please contact Roger Fernandez using the information below.

4. Email all materials to [email protected]. Contact Roger Fernandez (information below) with any issues or questions.

• Please note that all applicants must submit a green power use form in conjunction with the GPLA application (see the Green Power Use & Data Form section in this application). After the award application and green power use forms are submitted, EPA will confirm receipt and follow up with questions, if necessary.

Questions?

Email [email protected] or contact Roger Fernandez at (202) 343-9386 or [email protected].

Deadline

Friday, April 17, 2015 (11:59 pm eastern)

Applications will be accepted beginning February 23, 2015.

Application Form

Award Categories

Please check all that apply.

Green Power Purchasing On-site Generation Partner of the Year

Green Power Community of the Year (only EPA Green Power Communities are eligible)

Sustained Excellence (open to Partners that continue to demonstrate excellence and leadership

in their green power use)

Applicant Contact Information

Note: Please fill out the fields below with contact information for the organization applying for or being nominated for a Green Power Leadership Award.

Organization      
Contact Name      
Title      
Address (Street 1)      
Address (Street 2)      
City      	State      	Zip      
Phone      
Email      

Submitter Contact Information

Note: Please fill out the contact information below if you are a third-party submitting an application for another organization

If same as contact information above, check here and skip:

Organization      
Contact Name      
Title      
Address (Street 1)      
Address (Street 2)      
City      	State      	Zip      
Phone      
Email      
Relationship to Applicant      

Applicant’s Communications/Public Relations Contact

If same as applicant contact information, check here and skip:

Contact Name      
Title       
Phone      
Email      

Eligibility Questions

• Will the applicant have an operational on-site green power generator or a completed green power purchase in place by April 17, 2015? On-site green power is only eligible if the applicant owns the renewable energy certificates (RECs) associated with the system’s output. The green power purchase is considered complete when delivery is executed.

Yes No

Note: Applicants will be evaluated on the green power use they have reported to the Green Power Partnership as of April 17, 2015.

• Will the applicant maintain EPA Green Power Partner status by continuing to fulfill the Partnership Requirements (PDF) through the awards event? Yes No

• Scope of the applicant’s participation in the Green Power Partnership:

Organization-wide participation [Reported electricity use covers all owned and/or leased U.S. operations of Partner]

Facility-based participation [Reported electricity use covers a facility or group of facilities owned and/or leased by Partner]

If the applicant’s participation is facility-based, please list the facility or group of facilities included below.

     

Green Power Use Questions & Data Form

1. How much green power does the applicant use on-site and/or purchase annually?      (kWh/year)*

*If the applicant began using green power less than a year ago, please extrapolate the green power usage to an annualized amount.

Is this the applicant’s first year of using green power? Yes No

2. Has there been an incremental increase in the applicant’s total green power use since the close of the last GPLA application period (April 7, 2014)? If so, indicate the increased amount:      (kWh/year)

3. Complete the GPLA green power use data form and email to [email protected] with the rest of your award materials. Note, if the applicant is already an EPA Green Power Partner, you may request a form pre-populated with the applicant’s current information by emailing [email protected].

Essay Questions

Please note: if the applicant is selected to be an award winner, EPA may use the content of these essay answers to write the applicant’s award winner profile.

1. Why is the applicant worthy of national recognition for its green power usage? What role does green power play in the applicant’s broader business and environmental strategy? Please also discuss any innovative green power strategies the applicant has undertaken, and how the applicant has demonstrated leadership within its industry by using green power. (400 word maximum)

     

2. How did the applicant communicate its green power use? Beyond April 17, 2015, what future communications plans does the applicant have for promoting its green power usage? If selected, how will the applicant publicize its EPA Green Power Leadership Award internally and externally? (200 word maximum. Please note: EPA strongly encourages each award winner to attend the ceremony in person, issue a press release, promote its status as an award winner on social media, and post notice of the award on its website.)

     

3. How does the applicant build awareness about green power in general? What steps, if any, does the applicant take to encourage stakeholders to use green power? What are the applicant’s upcoming plans to continue doing so?

     

Communications Activities

• Please check the boxes in the correct column below and distinguish between activities led by the applicant and those led by other stakeholders such as providers, NGOs, etc.

• All selected activities should have a direct communications connection to the applicant’s green power use.

• If “Other” applies, please explain in supplemental page(s).

• Supplemental materials that correspond to the activities selected are encouraged. Please submit supplemental materials in the form of one combined PDF, if possible. You may submit no more than 10 pages of supplemental materials.

Green Power Related Public Relations	Applicant led	Stakeholder led	Materials submitted
Press releases
Press conference, announcement or dedication events
Media outreach/interviews/pitch stories
Educational kiosks/virtual tours
Promotion of ranking on EPA Top Partner List(s)
Other (please explain)

Green Power Related Marketing	Applicant led	Stakeholder led	Materials submitted
Public web page (please supply visitor statistics)
Paid print, radio, television advertising
Public service announcements
Product packaging
In-store communications/window stickers
Marketing collateral/brochures/catalogs/flyers
Public facing signage (office buildings, shuttles)
Other (please explain)

Green Power Related Stakeholder Outreach	Applicant led	Stakeholder led	Materials submitted
Speaking events/presentations/conferences/tradeshows
Stakeholder newsletters
Corporate intranet/internal Web announcements
Web casts/videos
Trade outreach (industry associations, tradeshow booth)
Supplier and distributor outreach (workshops, etc)
Stakeholder green power purchase opportunities
Corporate sustainability report
Sponsorships or partnerships (committees, task forces, events)
Other (please explain)

Continued on next page

Complete this section only if applicant is an EPA Green Power Community.

EPA Green Power Community Campaign Communications	Applicant led	Stakeholder led	Materials submitted
Posting of EPA Green Power Community road signs
Speaking events/town meetings
Campaign Outreach
Informational poster campaigns
Chamber of Commerce outreach
Direct mailings/utility bill inserts
Other (please explain)

1 Organizations may submit a Green Power Leadership Award application on their own behalf, OR third-parties may nominate an organization for an award. Use this application in either instance. The term “applicant” is used in both instances.