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

# 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

T he 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).

# Promotional Partner of the Year Application

Organization Name:

_____________________________________________________________________ Number of Employees:

___________________________________________________________________ Population Served or Number of Members (if applicable):

______________________________________ 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 

# 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., “Education and Outreach 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 promotional partners, this might include the number of brochures distributed, number of media impressions, value of incentives, survey results, and estimated water savings due to WaterSense-specific promotional efforts.

•	 Include sample or supporting materials in your application package to thoroughly demonstrate your accomplishments. For promotional partners, these materials might include sample brochures, articles, newsletters, photos, rebate forms, or other materials showcasing the WaterSense marks.

•	 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. Education and Outreach Activities (50 points)

•	 Describe how you conducted (including quantity and reach) WaterSense related consumer and/or member outreach activities . For example, this might include developing Web sites, writing and publishing newsletters, managing listservs, using billstuffers, producing public signage, giving presentations, and organizing events that promoted WaterSense.

•	 Describe how you conducted WaterSense related media activities (including quantity and reach) that resulted in increased public awareness about water efficiency and the WaterSense program. For example, this might include pitching public service announcements, creating and/or publishing articles or advertisements in newspapers, journals, or broadcast media that promoted WaterSense.

2. Measurable Results (20 points)

•	 Describe how you measured the effectiveness of your WaterSense related promotional
activities and include those metrics.

•	 Demonstrate how you have increased public awareness of the WaterSense brand and how you measured that increase in awareness.3. Incentive Programs (20 points)

•	 Describe relevant incentive programs or events your organization sponsored or promoted, which encouraged consumers to purchase WaterSense labeled products.
•	 Highlight quantifiable details. For example, this might include the number of times you offered incentives, the number of recipients participating in incentive programs, the value of your incentives, and the number of products the incentives covered.

4. Strategic Collaboration (10 points)

•	 Describe how you have collaborated with manufacturers, retailers, builders, landscape irrigation professionals, and other groups to promote WaterSense messaging. Include how your organization selected potential partners and the value the collaboration brings to the WaterSense program in your region.