OMB Control Number: 2060-NEW 

Expiration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10

U.S. EPA MONTREAL PROTOCOL 

AWARDS NOMINATION FORM 

INTRODUCTION 

The Stratospheric Protection Division of the U.S. 

Environmental Protection Agency (EPA) invites 

nominations for the U.S. EPA Montreal Protocol 

Awards. This award program was established in 

1990 to recognize outstanding contributions to the 

protection of the Earth’s stratospheric ozone 

layer. 

BACKGROUND & ORGANIZATION 

Since 1990, over 500 awards have been 

presented to outstanding individuals and teams, 

dedicated companies, forward-thinking 

organizations, and visionary government 

institutions from 54 countries. Awards are 

particularly prestigious because nominees 

compete globally against the accomplishments of 

many other potential awardees, and recipients are 

selected by previous awardees and EPA. 

EPA seeks nominations for the following 

accomplishments: originality and public purpose; 

leadership and corporate responsibility; global 

perspective and implication; actual elimination of 

ozone-depleting substance emissions; success in 

eliminating substances that deplete the ozone 

layer and contribute to climate change or in 

transitioning to alternatives with reduced 

environmental impact; or leadership in improving 

awareness of the harmful health effects of 

overexposure to UV radiation. Award recipients 

are leading by example. Their demonstrated 

commitment and extraordinary contributions 

inspire other individuals and organizations to 

make a difference in protecting the environment 

and public health. Their significant contributions 

help mitigate the health and environmental risks 

of ozone depletion, which include skin cancer, 

suppression of the immune system, cataracts, 

and damage to marine life and crops, as well as 

the health and environmental risks of climate 

change, which include air quality problems and 

damage to agricultural crops. 

AWARDS PANEL & SELECTION OF AWARD 

RECIPIENTS 

EPA’s Stratospheric Ozone Protection Program 

consults an international panel of judges about 

the nominations. The judges represent 

government, industry, and non-governmental 

organizations. EPA makes the final selections. 

INSTRUCTIONS 

All nominations must include an official cover 

letter from the nominator, a completed application 

form, and a one-page summary of 

accomplishments. Electronic submissions are 

preferred. Because the judges will not be able to 

conduct on-site visits, applicants are encouraged 

to submit supporting materials such as 

photographs, videos, technical descriptions, news 

clippings, and press releases. Please note that all 

submissions are final, and the application and 

supporting materials will not be returned. 

Nominations must be mailed, faxed or emailed no later than December 31. 

E-Mail (preferred): Vazquez.Kristinn@epa.gov 

Regular Mail: 

U.S. EPA Montreal Protocol Awards 

Attn: Kristinn Vazquez 

U.S. Environmental Protection Agency 

1200 Pennsylvania Ave. NW (6205J) 

Washington, D.C. 20460, USA 

Express Delivery (FedEx, UPS, DHL, etc.) 

U.S. EPA Montreal Protocol Awards 

Attn: Kristinn Vazquez 

Stratospheric Protection Division 

1310 L Street, NW, Room 1032 

Washington, D.C. 20005, USA 

QUESTIONS? 

For more information, visit: 

www.epa.gov/ozone/awards/

or contact Kristinn Vazquez at 1 (202) 343-9062 

or by e-mail at Vazquez.Kristinn@epa.gov

The public reporting and recordkeeping burden for this collection of information is estimated to average 2.5 hours 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, 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. 
OMB Control Number: 2060-NEW 

Expiration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10

U.S. ENVIRONMENTAL PROTECTION AGENCY MONTREAL PROTOCOL AWARD 

NOMINATION 

AWARD CATEGORY 

Individual Organization/Association/Group Corporate Government Team

Title of project or activity 

(if applicable)

Approximate date project began 

(if applicable)

Project status: 

(if applicable) Ongoing Complete 

INFORMATION ABOUT THE NOMINEE 

Name of award nominee 

(primary contact; include other names and info as well)

Address (if company or organization, use headquarters address) 

City State/ 

Province

ZIP/Postal 

Code

Country 

Phone E-mail 

Contact (if nominee is an organization) 

Contact phone Contact 

e-mail

INFORMATION ABOUT NOMINATOR 

Nominated by: Affiliation 

Address 

City State/ 

Province

ZIP/Postal 

Code

Country 

Phone E-mail 

REFERENCES 

Please identify two independent experts who can verify the accomplishment(s) of the person or organization nominated for the award. 

Name Affiliation 

E-mail Phone 

Address 

Name Affiliation 

E-mail Phone 

Address 
OMB Control Number: 2060-NEW 

Expiration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10

SUMMARY OF ACCOMPLISHMENTS 

Please summarize the nominee’s accomplishment in the space below, or attach a one-page summary (no longer than 600 words). 

SIGNATURE OF NOMINATOR 

I certify that my answers are true and complete to the best of my knowledge. 

Signature Date 

Please note- no signature necessary if form sent electronically from nominator’s e-mail account. 
OMB Control Number: 2060-NEW 

Expiration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10

ELIGIBILITY 

Candidates may be from anywhere in the world. 

Individuals and organizations may work for the public or private sector. 

Candidates may be either self-nominated or nominated by a third party. 

NOMINATION PROCESS 

Nominations should include a standard nomination form, a cover letter from the nominating 

individual/organization, a one-page summary of the candidate’s accomplishments, and supporting 

materials. 

 

SELECTION CRITERIA 

Award recipients must demonstrate one or more of the following criteria: 

o originality and public purpose; 

o leadership and corporate responsibility; 

o global perspective and implication; 

o success in eliminating substances that deplete the ozone layer and contribute to climate 

change or in transitioning to alternatives with reduced environmental impact; or

o leadership in improving awareness of the harmful health effects of overexposure to UV 

radiation. 

Actual (as opposed to anticipated) results/reductions are preferred. 

JUDGING PROCESS 

Nominations will be screened by a panel of judges selected for their expertise. Past awardees 

also serve on the judging panel. EPA makes the final selection of award recipients. 

 

PRESENTATION OF AWARDS 

Award recipients will be announced at the annual Awards Ceremony in the fall at a location to be 

determined. 

RECIPIENT BENEFITS 

Past recipients of the Award have noted their appreciation of the benefits that accompany this 

award. Those selected can expect to enjoy: the honor of receiving this prestigious, international 

environmental award; increased name recognition; improved employee morale; and personal 

satisfaction and affirmation of having made a real difference.