ED-GRS (2014-2015) Page 1 of 2

2014-2015 District Nominee Presentation Form

CERTIFICATIONS

District’s Certifications

The signatures of the district superintendent on the next page certify that each of the statements below concerning the 

district’s eligibility and compliance with the following requirements is true and correct to the best of the 

superintendent’s knowledge. 

1. The district has been evaluated and selected from among districts within the Nominating Authority’s 

jurisdiction, based on high achievement in the three ED-GRS Pillars: 1) reduced environmental impact and 

costs; 2) improved health and wellness; and 3) effective environmental education.

2. The district is providing the U.S. Department of Education Office of Civil Rights (OCR) access to 

information necessary to investigate a civil rights complaint or to conduct a district wide compliance review.

3. OCR has not issued a violation letter of findings to the school district concluding that the nominated school 

district has violated one or more of the civil rights statutes. A violation letter of findings will not be 

considered outstanding if OCR has accepted a corrective action plan to remedy the violation.

4. The U.S. Department of Justice does not have a pending suit alleging that the school district has violated one 

or more of the civil rights statutes or the Constitution’s equal protection clause.

5. There are no findings of violations of the Individuals with Disabilities Education Act in a U.S. Department of 

Education monitoring report that apply to the school district in question; or if there are such findings, the 

state or school district has corrected, or agreed to correct, the findings.

6. The district meets all applicable federal, state, local and tribal health, environmental and safety requirements

in law, regulations and policy and is willing to undergo EPA on-site verification.

U.S. Department of Education Green Ribbon Schools 2014-2015 District Sustainability Award

Name of Superintendent:

(Specify: Ms., Miss, Mrs., Dr., Mr., etc.) (As it should appear in the official records)

District Name:

(As it should appear on an award)

Address: 

Telephone: Fax: 

Web site/URL: E-mail: 

I have reviewed the information in this application and certify that to the best of my knowledge all information is 

accurate. 

 Date: 

(Superintendent’s Signature)
ED-GRS (2014-2015) Page 2 of 2

Nominating Authority’s Certifications

The signature by the Nominating Authority on this page certifies that each of the statements below concerning the 

district’s eligibility and compliance with the following requirements is true and correct to the best of the Authority’s 

knowledge.

1. The district is one of those overseen by the Nominating Authority which is highest achieving in the three 

ED-GRS Pillars: 1) reduced environmental impact and costs; 2) improved health and wellness; and 3) 

effective environmental education.

2. The district meets all applicable federal civil rights and federal, state, local and tribal health, environmental 

and safety requirements in law, regulations and policy and is willing to undergo EPA on-site verification.

Name of Nominating Agency:

Name of Nominating Authority:

(Specify: Ms., Miss, Mrs., Dr., Mr., Other) 

I have reviewed the information in this application and certify to the best of my knowledge that the school meets the 

provisions above.

 Date: 

(Nominating Authority’s Signature)

SUMMARY AND DOCUMENTATION OF NOMINEE’S ACHIEVEMENTS

Provide a coherent "snapshot" that describes how your district is representative of your jurisdiction’s highest achieving 

green school efforts. Summarize your strengths and accomplishments in all three Pillars and nine Elements. Then, 

include documentation and concrete examples for work in every Pillar and Element. 

SUBMISSION

The nomination package, including the signed certifications and documentation of evaluation in the three Pillars should 

be converted to a PDF file and emailed to green.ribbon.schools@ed.gov according to the instructions in the Nominee 

Submission Procedure.

OMB Control Number: 1860-0509

Expiration Date: February 28, 2015

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information 

unless such collection displays a valid OMB control number. The valid OMB control number for this information 

collection is 1860-0509. Public reporting burden for this collection of information is estimated to average 37 hours per 

response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection of information. The obligation to respond to this collection is 

required to obtain or retain benefit P.L. 107-110, Sec. 501, Innovative Programs and Parental Choice Provisions. Send 

comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for 

reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or 

email ICDocketMgr@ed.gov and reference the OMB Control Number 1860-0509. Note: Please do not return the 

completed ED-Green Ribbon Schools application to this address.