2024 Fairfax County Environmental Excellence Awards Nomination Form

2024 Fairfax County Environmental Excellence Awards Nomination Form

A nominee’s achievements should have occurred between June 1, 2023, through May 31, 2024, or over a period of years that include a portion of this time frame. The nominee must be located in or have an impact specific to Fairfax County, Virginia.

Nomination forms must be received by 11:59 PM on June 9, 2024.

To request this information in an alternate format, please call or email the Office of Environmental and Energy Coordination at 703-324-7136, TTY 711 or eqac@fairfaxcounty.gov.

Nominator Information

The section below should be filled out with information about the person nominating the below nominee. This information, including email, is needed to confirm the nomination

Name*

Email*

Phone Number*

Phone

Organization or Business

If applicable

Address

Ex. 123 Main Street, Fairfax, Virginia, 22030

Nominee Information

The section below should be filled out with information about the person or organization being nominated for an Environmental Excellence Award.

Name*

Honorific

Example: Mr. Ms. Mrs. Mx. Miss, n/a

Email Address*

Phone Number*

Phone

Organization or Business

If applicable

Address

Ex. 123 Main Street, Fairfax, Virginia, 22030

Nominee Category*

Individual/ County Resident

Organization

Business

County Employee

I acknowledge I have notified the nominee(s) of this nomination.*

Nomination Statement*

Please include no more than 750 words describing the contribution or achievement of the nominee, with details of their role and the extent to which their contribution has benefited Fairfax County. You may also upload a document with this statement.

Nomination File Upload

Please submit Word Documents or PDF documents only. Please label your document as "Nominee Name_Statement".

Drag and drop files here or

Send me a copy of my responses

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