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Region 8

Serving Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming and 27 Tribal Nations

EPA Region 8 External Award Nomination Sheet

   

Note: if you are nominating more than one person for an award, please visit this page .

NOMINATOR:


Title Dr. Prof. Mr. Mrs. Ms.

First name, Last name

Position/Title

Organization

Street or PO Box

City, State, ZIP

Telephone, Fax

E-mail Address:

AWARD CATEGORY:

Environmental Achievement Award
Friend of EPA Award
A Wade Vitalis Award
Frank DeCouteau Award

STATUTORY AUTHORITY: (check up to four)

Clean Water Act
Clean Air Act
Resource Conservation Recovery Act
Pollution Prevention Act

NOTE: Work done solely under other acts is not eligible for EPA award recognition

NOMINATION WRITE-UP:

BRIEF PROPOSED CITATION FOR AWARD:

NOMINEE:

Title Dr. Prof. Mr. Mrs. Ms.

First name, Last name

Position/Title

Organization

Street or PO Box

City, State, ZIP

Telephone, Fax

E-mail Address:

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