ED - GRS (201 4 - 201 5 ) Page 1 of 2



### 201 **4 -**  **201 5**  **Post -**  **Secondary Nominee**  **Presentation Form ELIGIBILITY CERTIFICATION**  **S College or University**  **Certifications** The signature of college or university President (or equivalent) on the next page certifies that each of the statements below concer

ning the institution’s eligibility and compliance with the following requirements is true and correct to the best of their knowledge . 1. The college or university has been evaluated and selected from among institutions within the Nominating Authority ’s juri sdiction, 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 and sustainability education . 2. The college or university 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 compliance review. 3. OCR has not issued a violation letter of findings to the college or university concluding that the nom inated college or university 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 college or university has violated one or more of the civil rights statutes or the Constitution’s equal protection clause. 5. There are no findings b y Federal Student Aid of violations in respect to the administration of Title IV student aid funds. 6. The college or university is in good standing with its regional or national accreditor. 7. The college or university meet s all applicable federal, state , local and tribal health, environmental and safety requirements in law, r egulations and policy and is willing to undergo EPA on - site verification. 

### U.S. Department of Education **Green Ribbon Schools 201**  **4 -**  **2015** Public 4 - Year Public 2 - Year Private Non - Profit Name of President/Chancellor : (Specify : Ms., Miss, Mrs., Dr., Mr., etc.) (As it should appear in the official records) Official College or University Name : (As it should appear on an award ) College or University Street Mai ling Address : (If address is P.O. Box, also include street address.) County : IP EDS Number* : Telephone : Fax : Web site/URL : E - mail : *Integrated Postsecondary Education Data S ys tem I have reviewed the information in this application and certify that to the best of my

k nowledge all information is accurate. Date : ( President’s/Chancellor’s Signature)ED - GRS (201 4 - 201 5 ) Page 2 of 2 **Nominating Authority ’s**  **Certifications** The signature b y the Nominating Authority on this page certifies that each of the statements below concerning the college or university ’s eligibility and compliance with the following requirements is true and correct to the best of the Authority ’s knowledge . 1. The college or university has been evaluated and selected from among institutions 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 and sustainability education . 2. The college or university meet s all applicable federal, state , local and tribal health, environment al and safet y 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 meet s the provisions above. Date : (Nominating Authorit y’s Signature) **SUMMARY AND DOCUMENTATION OF NOMINEE’S ACHIEVEMENTS**  Provide a coherent "snapshot" that describes how your college or university 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. **SU BMISSION**  The nomination package , including the signed certifications and documentat ion of evaluation in the three P illars should be convert ed 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 **P ublic Burden Statement**  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection display s 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 source s, 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 P rovisions. 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 I CD ocketMgr@ed.gov and reference the OMB Control Number 1860 - 0509 . Note: Please do not return the completed ED - Green Ribbon Schools a pplication to this address.