Form 9600-054 SIPM Awards Program Application Guide & Forms

School Integrated Pest Management Awards Program (Renewal)

2531.03 Attachment F-Form 9600-054 -SIPM Awards Program Application Guide & Forms

Excellence Award

OMB: 2070-0200

Document [pdf]

Download: pdf | pdf

Expiration Date: 5/31/2024
OMB Control No. 2070-0200
PRA 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. 2070-0200). Responses to this collection of information are voluntary however mandatory to
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Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this
address.

Tier 1: School IPM Great Start Award

The U.S. Environmental Protection Agency’s (EPA) School Integrated Pest Management (IPM)
Great Start Award is presented to school districts that have made a commitment to implement
an effective Integrated Pest Management program and that have taken the first steps towards
implementing IPM. The Great Start Award is one of five levels of IPM awards, which the EPA
presents to school districts or individuals. To find out which level of recognition is the best fit for
your district, visit https://www.epa.gov/ipm/school-ipm-recognition.

Recipients of the School IPM Great Start Award will receive:
•
•
•
•

A “Great Start in School IPM” certificate signed by an EPA official;
Recognition on EPA’s web site https://www.epa.gov/ipm/school-ipmrecognition;
Access to topical webinars, trainings, events and recognition and mentoring
opportunities;
Regular e-mail updates aimed at advancing your school IPM program.

Eligibility

For a school district to receive the Great Start Award, the district must:
• Comply with all state laws;
• Only allow pesticides to be applied by a certified pesticide applicator;
• Have a designated IPM Coordinator that is receiving regular IPM training;
• Have a written IPM Policy;
• Complete a self-assessment using an IPM checklist which addresses the pest-conducive
conditions and pest problems present in the district.

How to Apply

EPA FORM No. 9600-054

Expiration Date: 5/31/2024
OMB Control No. 2070-0200
U.S. Mail (or Special Delivery):
U.S. Environmental Protection Agency
Mailcode: LCRD/CE
Center for Integrated Pest Management
Office of Pesticide Programs (OPP) OCSPP
1201 Elm Street, Suite 500, Dallas, Texas 75270-2102

The application is a fill-in form, which will allow you to save what you have filled in on your
computer and submit it electronically via e-mail.
Applications for the Great Start Award are accepted year-round on a non-competitive basis. For
specific questions, contact the School IPM Awards Coordinator at [email protected] .

EPA FORM No. 9600-054

Expiration Date: 5/31/2024
OMB Control No. 2070-0200

Guidance for Completing the Great Start Application

An example of a thorough IPM program can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf.

School System/District Information

Please provide all of the information requested in the table below. Note: If the contact person for this
application is not in school during the summer break, please provide additional contact information
(e.g., cell phone, alternate contacts) to allow EPA to contact you if necessary about your application.
The application is a fill-in form, which will allow you to type your answers directly into the
form, save what you have filled in on your computer, and submit it electronically via e-mail.
IPM Coordinator Contact Information

School System/District Name:
Name of IPM Coordinator
Title
Department
Address
City, State, Zip Code
Telephone
Fax Number
E-mail Address

School System/District Profile

Total Number of Students
Total Number of Staff
Total Number of Facilities in Your
System/District (e.g., 45 schools, 5
educational support buildings)
Age Range of All System/District Facilities
(e.g., 5-90 years old)
Total Square Footage (ft2) of All
System/District Facilities (e.g., 1.5 million
ft2)
Total School District Budget
Number of School Facilities in Your
School System/District Participating in the
School IPM Program

EPA FORM No. 9600-054

Expiration Date: 5/31/2024
OMB Control No. 2070-0200

School System/District Information Statement of Compliance
with State Law
I certify that
School District is in compliance with the laws of the State of
, including the laws that pertain to pest management and pesticide application.

Signature

Print Name

Date

Your District’s Integrated Pest Management Program
Coordinator: Who is your district’s Integrated Pest Management Coordinator? When did this

person become the IPM coordinator? What is the role the IPM coordinator in managing pests and
pest-conducive conditions in your district?

Education: Does your district’s IPM Coordinator receive at least eight (8) hours of training per

year in Integrated Pest Management techniques? How or where does the coordinator receive this
training?

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Policy: Does your district have a written IPM Policy? A sample IPM Policy can be found at

https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf . Please attach a copy of the written IPM policy to this application.

Self-Assessment: Have you completed a self-assessment using an IPM checklist for some or all

of the facilities in your district? An example of a self-assessment checklist can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf. For what portion of the facilities in your district has an IPM self-assessment been
completed? Your application will be evaluated on whether you have completed a self-assessment
for at least some of the schools in your district, not on the findings of the self-assessment. Please
attach a copy of the completed checklist/s to this application.

Certified Applicator: Are all pesticide applications in your district performed by a certified
applicator? Please attach proof of certification to this application.

Narrative: Please use the space below to detail any aspects of your district’s Integrated Pest

Management program which you have not mentioned anywhere else in this application.

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Tier 2: School IPM Leadership Award

The U.S. Environmental Protection Agency’s (EPA) School Integrated Pest Management
(IPM) Leadership Award is presented to schools and/or school districts who make a seniorlevel commitment to establish and maintain sustainable IPM programs. The Leadership
Award is one of five levels of IPM awards, which the EPA presents to school districts or
individuals. To find out which level of recognition is the best fit for your district, visit
https://www.epa.gov/ipm/school-ipm-recognition.

Recipients of the School IPM Leadership Award will receive:
•
•
•
•

A “Leadership in School IPM” certificate signed by an EPA official;
Recognition on EPA’s Web site https://www.epa.gov/ipm/school-ipm-recognition;
Access to topical web conference calls, training, events, and recognition and
mentoring opportunities; and
Regular e-mail updates aimed at advancing your school IPM program.

Eligibility

For a school district to receive the National Leadership Award, the district must:
• Meet all requirements of the Great Start Award, including compliance with all
relevant state laws;
• Form an Environmental Health/IPM Committee;
• Provide IPM education for Custodial, Maintenance, Groundskeeper, Kitchen, and
Health staff members;
• Have a written IPM Plan in place;
• Conduct monthly inspections including insect and rodent monitoring stations;
• Provide pesticide use records and monitoring records;
• Store pesticides properly and notify the public when they are used;
• Maintain trash areas and keep dumpsters at least 50 feet from any school facility;
• Use door sweeps;
• Manage vegetation near buildings.

How to Apply

Interested candidates should complete the School IPM National Leadership Award application
and submit by e-mail, U.S. Mail, or special delivery services (Federal Express, United Parcel
Services, etc.). Applications for the Leadership Award are accepted year-round on a noncompetitive basis. For specific questions, contact Jennifer Lemon at [email protected].
The application is a fill-in form, which will allow you to save what you have filled in on
your computer and submit it electronically via e-mail.
All applications may be submitted by e-mail, U.S. Mail, or special delivery 2 services (Federal
Express, United Parcel Services, etc.).
E-mail:
[email protected]

EPA FORM No. 9600-054

OMB Control No. 2070-0200

U.S. Mail (or Special Delivery):
U.S. Environmental Protection Agency
Mailcode: LCRD/CE
Center for Integrated Pest Management
Office of Pesticide Programs (OPP) OCSPP
1201 Elm Street, Suite 500, Dallas, Texas 75270-2102

Guidance for Completing the Leadership Application

Clarification of the terms used in the attached application can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf..

School or School System/District Information

Please provide all of the information requested in the table below. Note: If the contact person
for this application is not in school during the summer break, please provide additional
contact information (e.g., cell phone, alternate contacts) to allow EPA to contact you about
your application, if necessary.
The application is a fill-in form, which will allow you to type your answers directly into the
form, save what you have filled in on your computer, and submit it electronically via e-mail.
IPM Coordinator Contact Information

School System/District Name
Name(s) of IPM Coordinator
and IPM Team Members (if
necessary, please include
an additional sheet listing all
IPM Team members)
Title
Department
Address
City, State, Zip Code
Telephone
Fax Number
E-mail Address

School System/District Profile

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Total Square Footage (ft2) of
All System/District Facilities
(e.g., 1.5 million ft2)
Total School District Budget
Number of School Facilities in
Your School System/District
Participating in the School
IPM Program

Please review the statements in each section and check all boxes that apply to your school or
school district IPM program.

School System/District Information Statement of
Compliance with State Law
I certify that
State of
application.

Signature

School District is in compliance with the laws of the
, including the laws that pertain to pest management and pesticide

Print Name

Date

Your District’s Integrated Pest Management Program
Great Start Award: Has your district previously received the Great Start Award? If so,
please state when your district received the award. If not, please briefly explain how your
district meets the requirements of the Great Start award (information on the Great Start award
can be found on the same website as the information for the Leadership award:
https://www.epa.gov/ipm/school-ipm-recognition

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Environmental Health/IPM Committee: Please describe the structure, membership,
responsibilities, and activities of your school district’s Environmental Health/IPM
Committee.

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Staff Education: Please discuss the IPM education your district provides for Custodial,

Maintenance, Groundskeeper, Kitchen, and Health staff members. Make sure to note the
frequency, duration, and structure of this education. If you have any documents used in this
process, please attach them to this application.

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IPM Plan: Does your district have a written IPM Policy? A sample IPM Plan can be found at

https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf. Please attach a copy of your school district’s IPM Plan to this application.

Inspections: Does your district conduct monthly inspections including the use of insect and
rodent monitoring stations? Please explain your district’s process for carrying out these
inspections. If you have any documents relevant for this item, such as a sample
inspection form, please attach them to this application.

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Pesticide Use and Monitoring Records: Does your district keep records of pesticide use

and of the results of its monthly inspections? Please describe your district’s process for
keeping these records and, if your district does so, reviewing and taking action based on the
records. Please attach a copy of a pesticide use record used by your district to this
application (can be a sample form or an actually used form).

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Pesticide Notification and Storage: Does your district follow the recommended procedures
for pesticide use notification and pesticide storage? Please describe how your district notifies
the public of pesticide use and how pesticides are stored in your district. If you have any
supporting documentation, such as a sample notification letter or posting, or photos of
your pesticide storage area, please attach it to this application.

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Trash Areas and Dumpsters: Does your district meet the requirements for proper
maintenance, sanitation, and placement of trash areas and dumpsters? If you would like to
provide photos of trash areas and dumpsters in your district, please attach them to this
application.

Door Sweeps: Has your district installed door sweeps on exterior doors and are the door
sweeps of proper quality? Please mention, if available, the brand of the door sweeps your
district uses.

Vegetation near Buildings: What is your district’s policy regarding vegetation near

buildings? Does your district meet the given requirements for visibility between structures
and vegetation?

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Narrative: Please use the space below to detail any aspects of your district’s Integrated Pest
Management program which you have not mentioned anywhere else in this application.

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Tier 3: School IPM Excellence Award

The U.S. Environmental Protection Agency’s (EPA) School Integrated Pest Management
(IPM) Excellence Award is presented to school districts that have implemented
exemplary IPM programs The Excellence Award is one of five levels of IPM awards,
which the EPA presents to school districts or individuals. To find out which level of
recognition is the best fit for your district, visit https://www.epa.gov/ipm/school-ipmrecognition.

Recipients of the School IPM Excellence Award will receive:
•
•
•

•

An “Excellence in School IPM” certificate signed by an EPA official;
Recognition on EPA’s Web site – [insert website];
Access to topical web conference calls, training, events, and recognition and
mentoring opportunities; and
Regular e-mail updates aimed at advancing your school IPM program.

Eligibility

For a school district to receive the Excellence Award, the district must:
• Meet all of the requirements of the Leadership Award, including compliance
with all relevant state laws;
• Prove that the Environmental Health Committee, Pest Management Professional &
school administration follow the IPM Plan proactively;
• Update the IPM plan annually;
• Provide IPM education and award certificates to all staff including teachers and
coaches;
• Conduct full quarterly inspections;
• Keep detailed maintenance and pest complaint records;
• Follow guidelines for pesticide selection and application;
• Exercise proper sanitation including: proper food storage, clean and sanitary;
kitchens and clutter-free classrooms and buildings;
• Keep structures free of gaps, holes and other pest entry points;
• Maintain the cleanliness of building exteriors.

Instructions

Interested candidates should complete the attached application and submit the application
by e-mail, U.S. Mail, or special delivery services (Federal Express, United Parcel Services,
etc.).
E-mail:
[email protected]
U.S. Mail (or Special Delivery):
U.S. Environmental Protection Agency
Mailcode: LCRD/CE
Center for Integrated Pest Management
Office of Pesticide Programs (OPP) OCSPP
1201 Elm Street, Suite 500, Dallas, Texas 75270-2102

EPA FORM No. 9600-054

OMB Control No. 2070-0200

The application is a fill-in form, which will allow you to save what you have filled in
on your computer and submit it electronically via e-mail.
Applications for the Excellence Award should be submitted by November 1st. Awardees
will be selected by the following January. For specific questions, contact the School IPM
Awards Coordinator at [email protected].

Guidance for Completing the Excellence Application

An example of a thorough IPM program can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf.

School System/District Information

Please provide all of the information requested in the table below. Note: If the contact person
for this application is not in school during the summer break, please provide additional contact
information (e.g., cell phone, alternate contacts) to allow EPA to contact you if necessary
about your application.
The application is a fill-in form, which will allow you to type your answers directly into
the form, save what you have filled in on your computer, and submit it electronically via
e-mail.
IPM Coordinator Contact Information

School System/District Name:
Name of IPM Coordinator
Title
Department
Address
City, State, Zip Code
Telephone
Fax Number
E-mail Address

School System/District Profile

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School System/District Information Statement of
Compliance with State Law
I certify that
State of
application.

Signature

School District is in compliance with the laws of the
, including the laws that pertain to pest management and pesticide

Print Name

Date

Your District’s Integrated Pest Management Program
IPM STAR: If your school district currently has certification through the IPM STAR

program, it is eligible to receive the Excellence Award automatically. If your district is
IPM STAR-certified, please attach documentation that confirms this certification to
this application.

Leadership Award: Has your school district previously received the Leadership Award? If
so, please state when your district received this award. If not, please affirm that your
district meets the criteria to receive the Leadership Award. The requirements of the
Leadership Award are available at this website: https://www.epa.gov/ipm/school-ipmrecognition. The IPM Plan is an especially important component of the Leadership Award
criteria and is also necessary to meet the criteria of the Excellence Award. Please attach
your district’s written IPM Plan to this application.

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Coordination of IPM Plan, Committee, Administration, and Pest Management
Professional: To qualify for the Excellence Award, a district must not only have an IPM

Plan and Environmental Health/IPM Committee but also demonstrate that the Plan is being
implemented and that the Committee is involved with the decisions of the district’s
administration and pest management professionals. Please describe how your district’s pest
management professional works with your district’s IPM Plan and how the Environmental
Health/IPM Committee interacts with district administration and pest management
professionals.

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IPM Plan Updates: To be successful, an IPM Plan must be adaptive to changing

conditions and needs. The IPM Plan must be updated annually to meet the criteria of the
Excellence Award; please describe the process by which your district updates its IPM Plan.
Who is responsible for updating the plan? What factors are considered?

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Staff Education: The Excellence Award requires that all staff, including teachers, coaches,
and administrative staff, receive IPM education and certificates (see application guide for
specific requirements). Please describe the education your district provides to staff. If you
have documents used for IPM education, such as lesson plans or training modules,
please attach it to this application.

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Full Quarterly Inspections: In addition to the monthly monitoring inspections required at

the Leadership Award level, the Excellence Award requires that your district conduct full
inspections on a quarterly basis. These full inspections should be conducted by the IPM
Coordinator and at least one other member of the Committee, accompanied by the district’s
pest management professional if the district contracts services from a pest management
professional. Please describe the process used in these inspections. If you have any
documents used for these inspections, please attach them to this application.

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Pest Sighting and Maintenance Records: Please describe how your school monitors and
records pest sightings and pest-related maintenance issues. Please attach the forms used
for pest sightings and maintenance requests to this application.

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Pesticide Selection and Application: Please describe your district’s process for

determining when and how to use pesticides, which pesticides your district uses, and how
frequently your district uses those pesticides. This includes any pesticides used by outside
contractors. If you have a document explaining your district’s pesticide selection and
application protocol, please attach it to this application.

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Food Storage, Kitchen Sanitation, and Interior Clutter: How does your district control

food storage, sanitation, and clutter so as to minimize pest-conducive conditions inside
school buildings? It is advised that you submit a filled-in checklist (of the same type
used in the Great Start Award application) to verify your district’s control of these
factors. In addition, please attach to this application any other documents that might
be helpful in establishing your district’s sanitation policies and conditions.

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Entry Points: Please verify that your district’s structures are free of gaps, holes, and other

entry points for pests. These are primarily on the exterior of buildings, although interior
gaps should be addressed as well. Please explain the process by which your district
monitors for entry points and addresses them when they are identified. It is recommended
that you submit a filled-in checklist (as in the previous requirement) to verify your
district’s control of structural entry points.

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Exterior Clutter and Harborage: Please verify that your district controls clutter and

harborage on school grounds. Explain how your district monitors for clutter and harborage
and how it addresses it when it is identified. Again, it is recommended that you submit a
filled-in checklist to support your application.

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Narrative: Please use the space below to detail any aspects of your district’s Integrated
Pest Management program which you have not mentioned anywhere else in this
application.

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Tier 4: School IPM Model of Sustained Excellence Award

The U.S. Environmental Protection Agency’s (EPA) School Integrated Pest Management
(IPM) Model of Sustained Excellence Award is presented to school districts that have
been given the Excellence Award in the past and that have demonstrated the continued
success and sustainability of their IPM programs. The Model of Sustained Excellence
Award is one of five levels of IPM awards, which the EPA presents to school districts or
individuals. To find out which level of recognition is the best fit for your district, visit
https://www.epa.gov/ipm/school-ipm-recognition.

Recipients of the School IPM Model of Sustained Excellence Award will receive:
•
•
•

•

A “Model of Sustained Excellence in School IPM” certificate signed by an EPA official;
Recognition on EPA’s web site – https://www.epa.gov/ipm/school-ipm-recognition;
Access to topical webinars, trainings, events and recognition and
mentoring opportunities;
Regular e-mail updates aimed at advancing your school IPM program.

Eligibility

For a school district to receive the Model of Sustained Excellence Award, the district must:
• Have received the Excellence Award at least two years prior to applying for the
Model of Sustained Excellence award;
• Presently meet all requirements for receiving the Excellence award;
• Provide documentation of its method for making its IPM program sustainable;
• Provide documentation of the results its IPM program has achieved;
• Demonstrate how it has communicated about its IPM program both internally
and externally.

How to Apply

Interested candidates should complete the attached application and submit the application by
e-mail, U.S. Mail, or special delivery services (Federal Express, United Parcel Services,
etc.).

E-mail:
[email protected]
U.S. Mail (or Special Delivery):
U.S. Environmental Protection Agency
Mailcode: LCRD/CE
Center for Integrated Pest Management
Office of Pesticide Programs (OPP) OCSPP
1201 Elm Street, Suite 500, Dallas, Texas 75270-2102
The application is a fill-in form, which will allow you to save what you have filled in on
your computer and submit it electronically via e-mail.
Applications for the Model of Sustained Excellence Award for a given year should be
submitted by November 1st. Awardees will be selected by the following January. For specific
questions, contact the School IPM Awards Coordinator at [email protected].

EPA FORM No. 9600-054

OMB Control No. 2070-0200

Guidance for Completing the Model of Sustained Excellence Application

An example of a thorough IPM program can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf.
.

School or School System/District Information

Please provide all of the information requested in the table below. Note: If the contact person
for this application is not in school during the summer break, please provide additional
contact information (e.g., cell phone, alternate contacts) to allow EPA to contact you if
necessary about your application.
The application is a fill-in form, which will allow you to type your answers
directly into the form, save what you have filled in on your computer, and
submit it electronically via e-mail.
IPM Coordinator Contact Information

School System/District Name:
Name of IPM Coordinator
Title
Department
Address
City, State, Zip Code
Telephone
Fax Number
E-mail Address

School System/District Profile

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Statement of Compliance with State Law

I certify that
School District is in compliance with the laws of the
State of
, including the laws that pertain to pest management and
pesticide application.

Signature

Print Name

Date

Your District’s Integrated Pest Management Program
Previous Excellence Award: When did your school district receive the Excellence
Award?

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IPM STAR: If your school district currently has certification through the IPM STAR

program, it automatically meets the criteria of the Excellence Award (it still must
demonstrate that it meets the additional criteria required by the Model of Sustained
Excellence Award, though). If your district is IPM STAR-certified, please attach
documentation that confirms this certification to this application.

Leadership Award: Please affirm that your district meets the criteria to receive the Leadership Award. The

requirements of the Leadership Award are available at this website: https://www.epa.gov/ipm/school-ipmrecognition. The IPM Plan is an especially important component of the Leadership Award criteria and is also
necessary to meet the criteria of the Excellence Award. Please attach your district’s written IPM Plan to
this application.

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Coordination of IPM Plan, Committee, Administration, and Pest Management
Professional: To qualify for the Model of Sustained Excellence Award, a district must

not only have an IPM Plan and Environmental Health/IPM Committee but also
demonstrate that the Plan is being implemented and that the Committee is involved with
the decisions of the district’s administration and pest management professionals. Please
describe how your district’s pest management professional works with your district’s
IPM Plan and how the Environmental Health/IPM Committee interacts with district
administration and pest management professionals.

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IPM Plan Updates: To be successful, an IPM Plan must be adaptive to changing

conditions and needs. The IPM Plan must be updated annually to meet the criteria of the
Model of Sustained Excellence Award; please describe the process by which your district
updates its IPM Plan. Who is responsible for updating the plan? What factors are
considered?

EPA FORM No. 9600-054

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Staff Education: The Model of Sustained Excellence Award requires that all staff,
including teachers, coaches, and administrative staff, receive IPM education and
certificates (see application guide for specific requirements). Please describe the
education your district provides to staff. If you have documents used for IPM
education, such as lesson plans or training modules, please attach it to this
application.

EPA FORM No. 9600-054

OMB Control No. 2070-0200

Full Quarterly Inspections: In addition to the monthly monitoring inspections required

at the Leadership Award level, the Model of Sustained Excellence Award requires that
your district conduct full inspections on a quarterly basis. These full inspections should
be conducted by the IPM Coordinator and at least one other member of the Committee,
accompanied by the district’s pest management professional if the district contracts
services from a pest management professional. Please describe the process used in these
inspections. If you have any documents used for these inspections, please attach
them to this application.

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Pest Sighting and Maintenance Records: Please describe how your school monitors

and records pest sightings and pest-related maintenance issues. Please attach the forms
used for pest sightings and maintenance requests to this application.

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Pesticide Selection and Application: Please describe your district’s process for

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Food Storage, Kitchen Sanitation, and Interior Clutter: How does your district control
food storage, sanitation, and clutter so as to minimize pest-conducive conditions inside
school buildings? It is advised that you submit a filled-in checklist (of the same type
used in the Great Start Award application) to verify your district’s control of these
factors. In addition, please attach to this application any other documents that
might be helpful in establishing your district’s sanitation policies and conditions.

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Entry Points: Please verify that your district’s structures are free of gaps, holes, and other
entry points for pests. These are primarily on the exterior of buildings, although interior
gaps should be addressed as well. Please explain the process by which your district
monitors for entry points and addresses them when they are identified. It is
recommended that you submit a filled-in checklist (as in the previous requirement)
to verify your district’s control of structural entry points.

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Exterior Clutter and Harborage: Please verify that your district controls clutter and

harborage on school grounds. Explain how your district monitors for clutter and
harborage and how it addresses it when it is identified. Again, it is recommended that
you submit a filled-in checklist to support your application.

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Program Sustainability: Please describe your school district’s strategy and efforts to

make its School IPM program sustainable. If you have a written sustainability plan,
please attach it to this application.

Questions to consider:
• Since winning the Excellence Award, what steps have you taken to put in place
policies or procedures that ensure your IPM plan will be sustained on a long-term
basis?
• How has the role of your IPM Coordinator/IPM Team changed over time? How
have you ensured the continued buy-in from team members, decision-makers,
staff, and the community over the years? How do you keep staff and others up-todate on your program and changes in policies or procedures related to IPM?
• What steps have you taken to ensure that your IPM program maintains top-level
administrative support? For example, how do you engage new system
administrators about IPM issues and your IPM program? How have you used
administrators as advocates for your IPM program?
• What obstacles have you encountered in advancing and sustaining your IPM
program? What steps have you taken to address these obstacles? How has
receiving a National Excellence Award helped you to advance your program
and address challenges?
• How do you maintain awareness of and support for your IPM program now that it
is established (and may be “old news”)? How has receiving a National Excellence
Award helped you to raise and sustain program awareness?

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Program Results: Please provide documentation of the results your district has achieved
using its School IPM program. Note that there are no quantitative requirements for
success here; the intention in asking for documented results is to ensure that results are
being collected. Possible items to document can include pest sightings, pesticide
application changes, missed school days, asthma incidents, financial benefits, or any
other quantities that can indicate IPM progress. Please attach your documented results
to this application.

Program Communication: An effective communications strategy (both internal to the

school system and external to the broader community) is a critical component of an effective,
sustainable IPM program. In this section, describe how you communicate to your school
community your IPM program’s goals, outcomes, and improvements, paying particular
attention to how your communications have changed as your program has matured. It is also
important to describe how you have used effective communications to ensure continued
support for your program and whether you have provided assistance to other school systems
seeking to improve their IPM. If you have a written communication plan, please attach
it to this application.

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Narrative: Please use the space below to detail any aspects of your district’s Integrated
Pest Management program which you have not mentioned anywhere else in this
application.

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Tier 5: School Integrated Pest Management Change Agent Award

The U.S. Environmental Protection Agency’s (EPA) School Integrated Pest Management (IPM)
National Change Agent Award is presented to individuals and organizations that have
contributed to the adoption and use of IPM policies in school districts at the community,
state, region, or national level. The Change Agent Award is one of five levels of IPM awards
which the EPA presents to school districts or individuals. To find out which level of recognition
is the best fit for your district, visit https://www.epa.gov/ipm/school-ipm-recognition .
Recipients of the School IPM Change Agent Award will receive:
• A “Change Agent for School IPM” certificate signed by an EPA official;
• Recognition on EPA’s web site – https://www.epa.gov/ipm/school-ipm-recognition ;
• Access to topical webinars, trainings, events and recognition and mentoring opportunities;
• Regular e-mail updates aimed at advancing your school IPM program.
Eligibility
For an individual or organization to receive the Change Agent Award, the individual or
organization must:
• Provide a detailed account of their actions contributing to school IPM, with
documentation of efforts to assess the results of those actions;
• Describe how they communicated with relevant educational entities (schools, school
districts, state boards of education, etc.) to facilitate their IPM efforts;
• Demonstrate how their efforts will result in sustainable changes;
• Provide documentation of an endorsement from at least one educational entity in order
to verify the significance of their activities.

How to Apply
Interested candidates should complete the attached application and submit the application
by e-mail, U.S. Mail or special delivery services (Federal Express, United Parcel Services, etc.).
E-mail:
[email protected]

U.S. Mail (or Special Delivery):
Environmental Protection Agency
1200 Pennsylvania Avenue, N.W.
Washington, DC 20460

The application is a fill-in form, which will allow you to save what you have filled in on your
computer and submit it electronically via e-mail.
Applications for the Change Agent Award for a given year should be submitted by November
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1st. Awardees will be selected by the following January. For specific questions, contact the
School IPM Awards Coordinator at [email protected].
Guidance for Completing the Change Agent Application

An example of a thorough IPM program can be found at
https://www.epa.gov/system/files/documents/2021-07/integrated-pest-management-toolkit2021_2.pdf.

Contact Information
Please provide all of the information requested in the table below. If you are submitting this
application on behalf of an organization, please provide the organization’s information rather
than your own unless indicated otherwise.
The application is a fill-in form, which will allow you to type your answers directly into the form,
save what you have filled in on your computer, and submit it electronically via e-mail.
Contact Information
Name (Individual or Organization)
Name of Key Contacts (if Organization)
Title
Department
Address
City, State, Zip Code
Telephone
Fax Number
E-mail Address
Contact Information of Person Providing Endorsement
Name
Title
Organization
E-mail Address

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Your Contributions to School IPM
IPM Actions: Please provide a summary of your (or your organization’s) efforts contributing to
the adoption, implementation, and/or improvement of IPM practices in the educational
setting.

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Results: Please describe how you or your organization measured the results of your efforts.
Note that the nature of such results will vary widely depending on the nature of the actions
taken.
Please attach any relevant results to this application.

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Communication: Please describe how you or your organization communicated with
educational entities (schools, school districts, state boards of education, etc.) and other
community members as part of your efforts toward advancing School IPM. If you have a
written communication plan, please attach it to this application.

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Sustainability: Please describe how you or your organization has ensured or will ensure that
the changes resulting from your efforts will be sustained in the future, or how you or your
organization has maintained or will maintain your efforts in the future. If you have a written
sustainability plan, please attach it to this application.

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Endorsement: Please provide documentation of an endorsement from an educational entity
involved with your efforts that verifies the significance of your IPM activities. This
endorsement can come from any level of the educational system, but it should match the
general level of your activities; if your work mostly was with individual schools or districts, an
endorsement could come from a principal or superintendent, but if you worked on state
policy issues, the endorsement should come from a state official or entity. The endorsement
should be no more than one page single-spaced and should be placed on official letterhead.
Please attach your endorsement to this application.

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File Type	application/pdf
Author	ltanner
File Modified	2023-07-26
File Created	2023-07-26