Application form
Entreprises
Application form have to be fulfilled and send back before
30th April 2013, 6.00pm
By email:
Or
By post:
CD2E
Rue Léon Blum - Base 11/19
62750 Loos-en-Gohelle
Or
By Fax: +33 (0)3 21 13 06 81
For further information please contact:
Rachel Debrincat, innovation consultant at cd2e
Tél.: +33 (0)3 21 13 06 80
Thanks to join your company logo (high definition format) and one picture (in jpeg format) showing your product, service or process.
Before fulfilling the application form, please read the eco-innovation prize rules and regulations carefully.
Application form N°: Recpetion date: [To be filled by cd2e]
Company Name
Key Words
Activity
Company presentation
Company Name:
Creation date:
Juridic status:
General presentation of the company (markets, type of clients, geographical areas covered):
Adress: / Telephone:
Fax:
website:
Contry:
Manager (surname, name, tel., email)
Do you belong to a multinational company
No, workforce:
If so, which one(entity, adress is different, work force):
Environord trade fair Participation, Eco-innovationPrize 2013
Attending the Environord trade fair 2013
If so, which boot:
 No
Already participated to the Eco-innovation prize?
 If so, which year:
 No
Person in charge of the aplication form (if someone different from the manager)
Name, Surname:
Fonction:
Tel.,email:
In which of the following category are you applying to?
 Product  Process  Service
Which of the following areas are you covering?
City of tomorrow  Industry of tomorrow Mobility and transport of tomorrow

Any additional document giving more details on the product, process or service you want to promote can be sent so as to better evaluate your application form.

Presentation of your project
product/process/service
Name/brand:
Date of the 1sttime on the market:
Short summary (120 words max. which will added in our promotionnal catalogue and show during the Environord trade fair)
Details (product/process/service details)
What kind of environmental issues does it adress?
(Issue to solve, details and fonctions of the innovation), (5 lines max)
Environmental thematic(s)
 Air
Life Cycle Analysis
 Noise /  Waste/Recycling
 Water
 Eco-building /  Energy
 Sites and polluted sediments
Others:
Innovation critieria: which are the differentquels sont les points de distinction par rapport aux produits, process, services se trouvant actuellement sur le marché?
Environmental innovation?
Efficiency and quality?
Cost?
Market launch outcomes (of your product, process or service)
Scientific, industrial and economic outcomes?
(Work Force, development strategies, technology transfer)
Environmental and social outcomes?(Améliorations effectives)
Collaborations and recognitions
Cooperations/partnerships associated(laboratories, entreprises, business support organizations)
Did you get any financial support for your project?
 If so, which fundings? (ex: Life, …):
 No
Contest/received award(s)
 If so, give additional details:
 No
Patent(s)
 If so, give additional details:
 No
Additional question
Which internal environmental approaches have you implemented?
Have you paid special attention to the Life Cycle Thinking of your product, process, service?
(Have you thought about the transport circuit, the use of ressources, end of life…)
Have you ever collaborate with a public or private laboratory? If so, which one (Name, location)? For what kind of project (name, type of project, aim of the project)
Signed on (City):Made this day / /2013
Name:Surname:
Fonction:
Signatureand stamp of the company:
We guarantee the confidential treatment of the given data. The information contain in the application form are exclusively reserved to the «Eco-innovation» prize 2013.
Rules and Regulations
This price is aiming at rewarding any SME that has developed an innovative environmental product, process or service.
1. You will be ask to state in which category your are applying:
  • Product
  • Process
  • Service
Environmental thematic:
Air, Life cycle analysis, Noise, Waste/Secondary raw materials/Recycling, Water, Eco-building, Energie, Sites and polluted soils and sediments
And, any direct link with any of these following areas covering:
  • City of tomorrow
  • Industry of tomorrow
  • Mobility and transport of tomorrow
2. 2013 Prices
Reward annoucement on June 4th 2013 at 12.00am at Lille Grand Palais. 4 prices will be given away:
  • 5000 euros (cash) for the first prize
  • 1 innovative eco-product prize: special package inclunding a free Environordboot+ a personalized business support by cd2e
  • 1 innovative eco-process prize prix Eco-process innovant : special package including a free Environord boot+ a personalized business support by cd2e
  • 1 innovative eco-service prize : special package including a free Environord boot+ a personalized business support by cd2e
Each laureate will benefit from a higher visibility through media coverage during the award ceremony and in the long run and through websites showcase (
3. Terms and conditions of participation
  • SMEs with less than 1000 employees
  • Having developed an innovative environmental product, process or service
  • The product, process or service must have been developed and put on the market during the last two years
  • The product, process or service must deal with ressources conservation or system efficiency issues or enable any preventive or curative action
  • To be a Nord-Pas-de-Calais or a European SME
4. Evaluation criteria
  • The degree of innovation (compared with other similar product, process or service)
  • The degree of environmental/social impacts of the product, process or service
  • The degree of economic impacts of the product
  • Internal environmental approaches
  • Received award and cooperation/partnerships implemented
5. Calendar
  • 30th April 2013: Application form deadline
  • Mid-May 2013: Selection of winners by the jury
  • 4th June 2013 at 12.00am: Reward annoucemnt at Lille Grand Palais

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