2010-11Minnesota Governor’s Awards
for Pollution Prevention - Partnership
Part One. Application Cover Page
Contact information of nominee partners
(In this category the award winners will receive two plaques paid for by the MPCA. If additional plaques are needed, award winners can make arrangements to pay for other plaques.)
All partners MUST be listed in order to receive an award. If needed place additional partners on a separate sheet.
Name
Affiliation
Address
City State Zip
Telephone Fax E-mail
Name
Affiliation
Address
City State Zip
Telephone Fax E-mail
Who is the main contact for the partnership project?
Name of the project, program, or activity as you would like to see it on the award.
Project or program activity dates:Beginning * Ending
*Project must be complete by submittal date of application.*
Contact information for person submitting application
Name
Affiliation
Address
City State Zip
Telephone Fax E-mail
Provide a one-paragraph description of the project or program
<Type paragraph here, field will expand>
Share your successes
Use the following table to summarize the pollution prevention results of your program or project. You only need to fill in results that apply to your project (spaces left blank because they do not apply will not affect the evaluation of your project). Contact MPCA at 651-757-2688 or toll-free 800-657-3864 if you need assistance with conversion factors or quantifying results.
Hazardous raw materials / lbs. / % / $
Non-hazardous raw materials / lbs. / % / $
Water use / gallons / % / $
Land use / acres / % / $
Energy use / kWh or Btu / % / $
Renewable energy substitution / kWh or Btu / % / $
Other / % / $
Waste/emissions / Amount reduced / % Reduction / Dollars saved
Hazardous waste / lbs. / % / $
Solid waste (non-hazardous waste) / lbs. / % / $
Air emissions / lbs. / % / $
Water pollutants / lbs. / % / $
Water runoff / cubic ft. / % / $
Other / % / $
How did you hear about the Governor’s Awards?
E-mail, MnSCN e-mail listserv, SBEAP newsletter, PCA website, previous winner, other.
This is the end of Part One: Cover page.Continue to Part Two: Write a description of the project.
Follow instructions on page 3. The description should be no more than 10 pages. Submit the cover page and description as an email attachment to . /
Contact MPCA at 651-757-2688or toll-free 800-657-3864 for further information or assistance
Part Two. Written description of the project
Provide a written description of your program or project that includes information described in the following outline. The description should be no more than ten pages.
Use this outline as a guide whether your project is in green chemistry and design, renewable energy, industrial or institutional pollution prevention, green building, sustainable community development, low-impact development, or any other project or program to reduce waste and toxicity.
All applications will be judged on the following criteria: environmental benefit, economic benefit, leadership, innovation, transferability, motivation, and strength of partnership.
1. Benefits to the environment
Summarize your project or program’s results.
- Describe the environmental, ecological, employee or customer health benefits experienced or expected for the life of the project, including those associated with life-cycles of products or materials.
- Explain how the success of your project eliminated or reduced waste or toxicity or pollution as compared to past years or as compared to standards, averages or common practice? What reductions resulted from the implemented changes? Have these reductions led to improvements in employee health?
2. Economic benefits
Discuss the costs and economic benefits of the project or program.
- Include project or program costs, savings and/or increased revenues and decreased disposal and/or raw material costs as a result of the program.
- Include the payback period needed to recover project or program costs.
- Describe any marketing advantage your organization may have received as a result of the project or program.
3.Commitment and leadership in pollution prevention
Describe how your organization demonstrates commitment and leadership in pollution prevention both internally as well as with suppliers and customers, and the level of community leadership or involvement in the project or program. Describe the effects your program has had on others already, or how it may impact others in the future. Will it promote environmental awareness? Does it provide leadership for other government agencies?
4.Innovation
Describe how the project or program is innovative or unique. Explain how the activities go beyond what is commonplace in your industry, community, or organization.
5.A model for others (transferability)
Explain how the project or program lends itself to replication by others.
6. Motivation
Explain what motivated your organization to initiate the project. If the project was a direct result of enforcement action, please state that and explain how the program goes above and beyond the corrective issues required.
7. Partnership
Explain the roles and responsibilities of each organization involved in the project and how the partnership serves as a model for others. All partners must be listed. Organizations that are not listed can’t be added at a later time.
8. Other benefits
Describe other benefits that do not fit under the above categories.
Submit entries by Noon on September 15, 2010
Submit one application electronically via e-mail to .
All will be reviewed for eligibility and completeness.
Questions?Contact MPCA at 651-757-2688 or toll-free 800-657-3864.
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