(866) WTR-SENS (987-7367) · www.epa.gov/watersense · watersense@epa.gov

2009 WaterSense® Awards

OMB Control Number 2040-0272

Approval Expires 01/31/2010

The public reporting and recordkeeping burden for information collection requirements associated with the awards application for each respondent is estimated to 

be 21 hours. 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. 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 Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. 

Instructions

The U.S. Environmental Protection Agency’s WaterSense program is pleased to recognize the 

accomplishments of its partners. Partners in each category contribute to our shared mission of 

protecting the future of our nation’s water supply by promoting water-efficient products, services, 

and practices. 

To apply for a WaterSense award, please complete the following steps:

1. Ensure Eligibility. To be eligible for an award, you must have become a WaterSense partner 

prior to January 1, 2009. In addition, you must have submitted your 2009 WaterSense annual 

reporting form.

2. Complete the Awards Application Form. Please fill out the brief application form, including 

your contact information, eligibility confirmation, and a description of your organization.

3. Compose a Written Statement. Please prepare a short, written statement that addresses each 

of the evaluation criteria for your award category. Your written statement must be no more 

than five (5) pages in length. (Please organize and label your responses to coincide with the 

evaluation criteria categories). Your responses should address WaterSense-related efforts and 

accomplishments that you conducted in 2008. 

4. Compile Supporting Materials. Please include sample or supporting materials that clearly 

demonstrate how your organization has supported the WaterSense program mission. The 

materials should complement your written statement and provide WaterSense with tangible 

examples of your outreach activities. Please refer to the category-specific instructions for your 

sector for a list of examples. 

5. Submit Two (2) Copies of the Complete Award Application Package. Mail two (2) copies 

of your complete application package, including the application form, written statement, and 

sample or supporting materials to:

WaterSense

c/o ERG

2300 Wilson Blvd., Suite 350

Arlington, VA 22201

Your application package must be postmarked no later than April 10, 2009. 

If you have questions, please contact the WaterSense Helpline by e-mail at watersense@epa.gov or 

by calling toll free: (866) WTR-SENS (987-7367). 
Retailer/Distributor Partner of the Year Application

Organization Name: _____________________________________________________________________

Number of Stores/Showrooms: ___ and/or Number of Customers: ___and/or Number of Employees: __

Contact Name: _________________________________________________________________________

Contact Title:___________________________________________________________________________

Contact Phone:__________________ Fax: _________________ E-mail: ___________________________ 

1. Please verify your eligibility:

❏ Joined WaterSense partnership prior to January 1, 2009? Date joined:_________________

❏ Submitted 2009 annual reporting form? Date submitted: _____________

2. Please provide a brief description (no more than 300 words) about your organization. If you are 

selected to receive an award, this text will be the basis for describing your organization in award 

recognition materials. Attach an additional page if necessary.

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

3. To complete the application process, carefully 

review the written statement instructions 

and evaluation criteria, prepare your written 

statement, and submit your complete 

application package by April 10, 2009.

EPA Form Number 6100-17. (866) WTR-SENS (987-7367) · www.epa.gov/watersense · watersense@epa.gov

2009 WaterSense® Awards

Important Dates

Annual reporting form deadline: March 2, 2009 

Application deadline: April 10, 2009 

Award winner notification: June 19, 2009 

Recognition ceremony: October 7-9, 2009

OMB Control Number 2040-0272

Approval Expires 01/31/2010
Written Statement Instructions 

Please compose your written statement by addressing each of the following evaluation criteria based 

on your activities in 2008. Organize and label your statement using the categories listed below (e.g., 

“In-Store Promotional Activities”). In total, your written statement must be no more than five (5) pages 

in length, not including sample or supporting materials.

To strengthen your application:

•	 Include measurable results wherever possible. For retailer and distributor partners, this might

include the number of advertisements or circulars featuring WaterSense labeled products, number 

of Web page views, value of incentives, number or percentage of WaterSense labeled products 

stocked on shelves, number or percentage of markets carrying WaterSense labeled products, for 

example. 

•	 Include sample materials in your application package to demonstrate your accomplishments.	

For retailer and distributor partners, sample materials might include sales staff training materials, 

in-store marketing materials, or promotional items. 

•	 Organize your written statement to address the evaluation criteria and avoid double	

counting your activities across categories.

WaterSense will evaluate your application based on your written statement in response to the criteria 

below. The point values following each category indicate the maximum potential value for all activities 

within that category.

Evaluation Criteria 

1. In-Store or Showroom Promotional Activities (40 points) 

•	 Describe the WaterSense labeled products your organization sells and detail how your

organization promotes these products to customers within the store or showroom, such as 

through in-store events, point-of-purchase materials, shelf talkers, or collateral placements.

•	 Describe your methods for training sales associates about water efficiency and the WaterSense

labeled products you sell. Demonstrate how your sales associates in turn educate your 

customers about WaterSense labeled products and ensure that their purchasing experience is 

seamless.

•	 Provide the number and/or percentage of your organization’s stores that offer WaterSense

labeled products and describe how you plan to continue and expand the promotion of 

WaterSense labeled products. 

2. Other Promotional Activities (40 points) 

•	 Describe other efforts designed to promote WaterSense labeled products to your customers,

such as through print and broadcast advertisements, circulars, or online promotions. Provide 

samples and describe the prominence of these efforts by including the number and frequency 

of the promotions.

•	 Describe incentives your organization offered to customers for purchasing WaterSense

labeled products. Provide sample materials used with the incentives and provide quantifiable 

results, if possible. 
3. Use and Visibility of WaterSense Marks (10 points) 

•	 Describe how and where your organization has used the WaterSense marks to 	promote the

WaterSense program and/or your WaterSense partner status. 

4. Strategic Collaboration (10 points) 

•	 Describe how your organization has collaborated with manufacturers, promotional partners

(e.g., utilities, nonprofits, trade associations, state and local governments), or other retailers 

or distributors to further a common goal of increased water efficiency. Provide quantifiable 

results, if possible, and explain how this collaboration relates to the WaterSense mission.