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KLCFDC'S ENVIRO~NITIATIVE PROGRAM - SUBMISSION FORM

Application 2010 / 2011
Received:_______________ Submission Number:_______________(For KLCFDC Use Only)

(*) Indicates a required field.

Are you a Business, Not-For-Profit Organization, Student, School Group or an Individual?
(Details, including Business Registration # if required)
* Name:
Address:
* Phone Number(s):
Fax Number (If Available):
* Email Address:
Please select one of the following categories:
ENVIRO~NITIATIVE idea for the Community
New Product I've/We've developed
New Technology / method to improve something existing
Other ENVIRO~NITIATIVE
* What is your ENVIRO~NITIATIVE and how does it work?
* How is your ENVIRO~NITIATIVE unique or a new improvement?
* How did you come up with the idea for your ENVIRO~NITIATIVE?
* How will your ENVIRO~NITIATIVE benefit the City of Kawartha Lakes? (Creating Jobs, Reducing Carbon Footprints, Saving Water, etc...)?
* Is your ENVIRO~NITIATIVE something that will benefit communities outside of the City of Kawartha Lakes as well? If so, how?
* Do you believe that your ENVIRO~NITIATIVE can be commercialized? If so, how?

* Are you using or do you have a proposed effective and consistent method of measuring the benefits or impacts of your ENVIRO~NITIATIVE?

If so, what is an estimate of the impact your ENVIRO~NITIATIVE will have (ie: Gallons of water saved, tonnes not going to Landfill, etc...)?

 

Thank you for providing this information.  Upon our receipt of your submission, your document will be reviewed to determine if clarification is required and/or if there are any omissions, at which time someone may contact you from the KLCFDC or the ENVIRO~NITIATIVE Judging Committee.

Your submission will then be evaluated with all others received at our offices before Noon, on Thursday, March 31st 2011.

At the conclusion of this, first-ever ENVIRO~NITIATIVE, the Committee will select the best ENVIRO~NITIATIVEs and once it can confirm the effective quantitative measurement and delivery of the objectives as the applicant has stated them, the awards will be given in the following two categories----1) business/ organization/ school  and 2) family/ individual/ household. We anticipate this to take place prior to spring 2011.

All applicants must agree to the publication and dissemination of their ENVIRO~NITIATIVE  so that the others and the communities of the City of Kawartha Lakes have the opportunity to implement your initiative, thereby benefiting the community as a whole.  The winning submissions must further agree to take part in a publicity and public awareness campaign for their ENVIRO~NITIATIVE and the program overall.

Where your ENVIRO~NITIATIVE involves a new product or technology that could benefit from further research and development , you may be contacted by the Industry Innovation Office of Fleming College.     If this is the case, you will be notified before anything is agreed to and undertaken.  All efforts will be made to provide confidentiality and protection for the individual/ product. Full details with respect to the potential commercialization of a product or technology will be determined between Sir Sandford Fleming College and the applicant.

If you want more information, please go to our website, www.KLCFDC.com and look for the ENVIRO~NITIATIVE logo and then follow the links.

If you still have further questions, please contact Jennifer Hickson at the KLCFDC office, (705) 328-0261, extension 30.  Please provide a hard copy or electronic signature below to confirm your understanding of the Kawartha Lakes ENVIRO~NITIATIVE, its obligations and responsibilities and to save harmless any individuals including the Board of Directors of the KLCFDC and all participating sponsors and judges.

“I hereby state my understanding of the ENVIRO~NITIATIVE Program, agree to the conditions of its operation, and to both the terms herein—which may be required to change but if so, I will be advised.”

“By  providing this submission, I acknowledge my understanding and agree to participate truthfully, with no intent of malice or action to its organizers, sponsors and other participants.”

 
Name / Signature Business (if applicable) Date


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Veillez appeler 1-800-567-2345 ou nous contacter en français á l'addresse info@klcfdc.com

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