### Section I: General Information

Format (xxx xxx xxxx) New primary contact for WaterSense Email and/or telephone update Please update your interests and preferences to receive more specific communications from WaterSense.
P lease enter a number without commas. Yes No Yes No 

### Section II: Promotional Activities Please indicate what types of WaterSense promotional activities you conducted last year and what you plan to implement in 2013. Organization Name * 6 Please select

... Contact Name * Email Telephone Contact Update? g

f e d c g f e d c

I f water provider, population served Is the area you serve currently experiencing water shortages? * n m l k j n

m l k j D o you anticipate that the area you serve will experience water shortages in the next 5 years? * n m l k j n

m l k j

2012 2013 Website promotion with link to WaterSense g f e d c g f e d c C overage on social media outlets (e.g., Facebook, Twitter) g f e d c g f e d c P rint advertising g f e d c g f e d c T elevision/radio advertising g f e d c g f e d c N ewsletter or trade journal article g f e d c g f e d c C onsumer handouts g f e d c g f e d c P ublic signage g f e d c g f e d c E xhibit at public fair, conferences, events g f e d c g f e d c B ill insert g f e d c g f e d c Wo rkshop for consumers g f e d c g f e d c Wor kshop/training for contractors g f e d c g f e d c P resentation(s) to schools, community groups, etc. g f e d c g f e d c P romotion of WaterSense irrigation partners g f e d c g f e d c R ecruitment of new WaterSense partners g f e d c g f e d c I ncentive programs (e.g., tax- free holidays, rebates, giveaways) g f e d c g f e d c P romotion of new homes g f e d c g f e d c P romotion of We're for Water g f e d c g f e d c P romotion of Fix a Leak Week g f e d c g f e d c P romotion of Shower Better g f e d c g f e d c O ther g f e d c g f e d c If your organization participated in or hosted WaterSense promotional activities or events, please describe your activities (e.g., We're for Water, Fix a Leak Week, WaterSense labeled product demonstration, etc.)

5

6 Did you use any WaterSense marketing materials in 2012 (e.g., bill stuffers, brochures, fact sheets)? Are there any other tools or materials you would like to see WaterSense develop in 2013?

5

6 Describe any other ways you promoted or educated the public about WaterSense in 2012. 

## Page 1 of 3Add your 2012 activities to our WaterSense in Action Partner Story page so others can learn from your success! 

### Section III: WaterSense Program Feedback In the interest of serving you better, EPA would like to learn more about your opinions and information needs regarding the WaterSense program. Please complete the following section to provide feedback to EPA.

Yes No

Please go to the awards page for application materials and instructions. Award application materials will be available on the WaterSense partner website by February 1.



### Section IV: Incentive Programs If you offer rebate and incentive programs, please fill out the section below. If not, click "Next Page" at the bottom of the page. For each product type below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31, 2012. If you have a tracking sheet, feel free to attach it to this form. 5

6

On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense program? * 6 Please select

... How has WaterSense added value? * 5

6 On a scale of 1 to 5 (5 = most valuable), how valuable do you find the WaterSense partner website? * 6 Please select

... In the past year, how often have you visited the partner website? * 6 Please select

... By completing your annual reporting form, you will be eligible to apply for a 2013 WaterSense Partner of the Year award. WaterSense encourages all partners to apply regardless of organization size. Are you planning to apply for an award this year? * n m l k j n

m l k j Help us improve the awards program by telling us why you're not intereste d in applying for an award. *

5

6

Please provide suggestions for improving the WaterSense program (e.g., tools/materials, webinar topics, communications, Helpline, websites, etc.) *

5

6

Tracking Sheet Upload (Optional) Browse...

Type of Incentive # WaterSense

Incentives Issued** # Non-WaterSense

Incentives Issued # Combined

(WaterSense and Non-WaterSense) Incentives Issued Other Incentive Type

Toilets 6

Please select

... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas. Bathroom Sink Faucets 6

Please select... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas. Faucet Accessories 6

Please select

... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas.
Showerheads 6

Please select

... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas. 

## Page 2 of 3** Products must be independently certified to meet EPA criteria in order to earn the WaterSense label. E.g., not all ≤ 1.28 gpf (high-efficiency) toilets are WaterSense labeled, only those tested and certified as such. Please refer to the WaterSense labeled product list at www.epa.gov/watersense

. I f you are planning to offer rebates in 2013, please complete our Incentive and Rebate Form to make sure you are listed on the Rebate Finder on the WaterSense website. 

### Section IV: Incentive Programs Continued For each type of product below, please provide the type of incentive and quantity issued between January 1, 2012, and December 31, 2012. If you have a tracking sheet, feel free to attach it to the previous page.

On the following page, you will be asked to review your responses. You must select "c onfirm" at the bottom of the following page to submit your Annual Reporting Form to WaterSense. Please note, you may need to try different printer settings or print as a PDF to print the full report for your records. We apologize for any inconvenience.

Need assistance with this form? Flushing Urinals 6

Please select... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas. Weather- Based Irrigation Controllers 6

Please select

... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas. Irrigation Professionals 6

Please select

... Please enter a number

without commas. Please enter a number

without commas. Please enter a number

without commas.

Product Type Incentive Type # Non-WaterSense Incentives Issued Other Incentive Type

Other 6 Please select

... Please enter a number

without commas.
Other 6 Please select

... Please enter a number

without commas.
Other 6 Please select... Please enter a number

without commas.
Other 6 Please select

... Please enter a number

without commas.
Other 6 Please select

... Please enter a number

without commas.
Other 6 Please select

... Please enter a number

without commas. Add more products

Next Page 

## Page 3 of 3