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199 National Environmental Achievement Awards
General Information Sheet

Individual Achievement

_____Public Serive Award
____Federal           _____State      _____Local
_____Distinguished Performance Award
_____President's Award
_____Environment Award

Nominee Information

Name of Nominee:__________________________________________________________
Title__________________________________________________________

Member Agency Achievement

_____Research Technology Award
_____Operations Award
_____Public Service Award
_____Public Information & Education Award
     _____Video      _____Printed Publication      _____Educational Program

Agency Name:__________________________________________________________
Project/Program Name:__________________________________________________________

Community's Chief
Elected Official:
(name, title, address)

__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

Nominee Information

Nominee Address:__________________________________________________________
__________________________________________________________
__________________________________________________________

Nominee Phone
Number:

__________________________________________________________

Nominator Information

Nominee Address:__________________________________________________________

Agency or Company
Name:

__________________________________________________________

Phone Number

__________________________________________________________

Please return with summary overview by December 12, 1997
Return to MU97-22