Information About You

Company Affiliation (Select One)

---Executive/OwnerEmployeeOther

Information About the Nominee

Place of Business NationalCaliforniaOrange County

1. Size of company/entity by way of number of employees, or approximate revenue/year:

2. Green and Conservation Programs/Products implemented or launched in the last three years (list year of implementation/launching).

3. Name of Environmental Coordinator:

4. Environmental Coordinator reports to:

5. List incentives given for Green initiatives proposed by employees (if this is for a city or agency, initiatives proposed may also come from residents):

6. List incentives given for conservation initiatives/programs proposed by employees (if this is for a city or agency, initiatives proposed may also come from residents):

7. Allocated budget for conservation and/or green programs:

8. List all upgrading/retrofitting done on the facility/facilities to be more eco-friendly.

9. Environmental Impacts derived from the Green/Conservation programs (conservation of water, acid rain reduction, reduction of gas emission, conservation of energy, use of recycled material, use of natural biodegradable raw materials, etc.)

10. Recognition and awards received by company/city/agency on their green/conservation programs and projects and source of award (list all -not limited to last 3 years)

ANTI-SPAM: What is thirteen minus 7? (Give the answer as a number)*