OMB Control Number: 2060-NEW Expi ration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10 

# U.S. EPA MONTREAL PROTOCOL

AWARDS NOMINATION FORM

INTRODUCTION 

## The Stratospheric Protecti on 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 Eart h’s stratospheric ozone layer.

BACKGROUND & ORGANIZATION 

## Since 1990, over 500 awards have been presented to outstanding i ndividuals and teams, dedicated companies, forward-thinking organizations, and visionary government

institutions from 54 countries. Awards are particularly prestigi ous 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: origi nality and public purpose; leadership and corporat e responsibility; global perspective and implication; actual elimination of ozone-depleting s ubstance 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 radi ation. 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 si gnificant 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

RE CIPIENTS 

## EPA’s Stratospheric Oz one Protection Program

consults an internationa l 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. Electr onic 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 releas es. 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 Va zquez.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, in cluding through the use of automated collection techniques to the Director, Collection Strategies Di vision, U.S. Environmental Prot ection Agency (2822T), 1200 Penns ylvania 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 Expi ration 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 a pp licable )

Approximate date project began ( if a pp licable )

Project status: ( if a pp licable ) Ongoing Complete



### INFORMATION ABOUT THE NOMINEE

Name of award nominee (p rimar y 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 aw ard.

Name Affiliation

E-mail Phone

Address

Name Affiliation

E-mail Phone

AddressOMB Control Number: 2060-NEW Expi ration Date: 6/30/13

EPA Form # 5900-15, Revised 06/10 

### SUMMARY OF ACCOMPLISHMENTS

Please summarize the nominee’s accomplishment in the space belo w, 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 deplet e the ozone layer and contribute to climate change or in transitioning to alternat ives with reduced environmental impact; or

o leadership in improving awareness of the harm ful 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 th eir expertise. Past awardees also serve on the judging panel. EPA make s 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 recognit ion; improved employee morale; and personal

satisfaction and affirmation of having made a real difference.