VCIB Community Champion Submission Form

The Vancity Investment Bank Community Champion Award

This award is designed to recognize "Community Builders” - organizations that are already community focused and driving positive social & economic change, but which aren’t as frequently recognized for their positive environmental impact. It will be awarded to an organization that is primarily bringing community / social benefits and which is ALSO taking action to bring environmental change We're very pleased to have the support of Vancity - itself a driver of positive social and environmental impacts - as our champion in creating the award, and supporting our search for a deserving winner!

Name of the Primary Contact for this submission*

Prefix First Last Organization Title

Do NOT attempt to add more than one name. If there are additional team members, they can be added elsewhere, This should be the executive project leader of the organization leading the project

Email #1

Mobile Phone*

Office Phone*

Extension if any

Please enter a number from 0 to 99999.

Is there a second organization involved?*

Yes
No

Name of the Primary Contact for the second organization*

Prefix First Last Organization Title

Do NOT attempt to add more than one name. If there are additional team members, they can be added elsewhere, This should be the executive project leader of the organization leading the project

Email #2*

Mobile Phone*

Office Phone*

Extension Number if Any

Please enter a number from 0 to 99999.

Sum up the purpose of your organization in short form: The why, the objectives, the work accomplished, and the end result, in no more than 5 short sentences: / 100 words*

If selected, this will be the VERY short description of the project we use to describe it in our publication, and on the Clean50 website. You have 500 characters to work with.

Describe how the organization is making a positive social and/or economic contribution in your local community.*

Please include the SIZE of your organization (staff / volunteers / number of stakeholders served) and especially please note if you are meeting a need otherwise not met or under-served within your community.

Does the organization have an environmental management system (EMS) covering waste generation, energy usage, water usage, and carbon emissions that includes any of the following? Please check all that apply.*

Policy statement documenting the organization's commitment to the environment
Assessment undertaken of the environmental impact of the organization's business activities
Stated objectives and quantifiable targets for environmental aspects of the organization's operations
Programming designed, with allocated resources, to achieve these
Periodic compliance and auditing to evaluate programs conducted
No environmental management system

What percentage of energy use is produced from renewable sources?*

Does the organization monitor, record, or report its energy usage? If so, what percentage of energy use is produced from renewable sources?

Describe the conservation and efficiency improvement efforts taken to date.*

Have conservation and efficiency improvements led to energy savings for the organization’s facilities? If so, by how much?

If you win, will a representative be available to participate in the all-day Clean50 Summit on October 8th (if not rescheduled)?

YES! absolutely will not miss it
No - sorry - our budget will not extend to include travel
No - regardless of status of COVID - not chancing anything
No - Some other non-COVID related reason

We will not host the summit on October 8th if there is a restriction on gathering size then in effect anywhere in Canada at any time in September or October

License Agreement

Please read this carefully. There is no cost to be considered, or to win any Clean50 Award. Nor do we require that finalists buy an expensive dinner for 8 people to attend an award ceremony as some Awards insist nominees do. Winning individuals and projects are notified they have won and not dependent upon anything, other than as outlined below. IF you win, you will need to sign a licensing agreement (but not pay anything) in order to accept the award. The agreement does not obligate you to pay anything unless you choose to use the award to gain some commercial or reputational advantage. The publicity we provide, the space on our website, the reference in the Globe and Mail are all free. And there is no obligation for the organization to self-identify as a Clean50 Project Award winners. HOWEVER - if you win and you do want to self-identify as a Clean50 Top Project Award winner, you will be required to first pay a licensing fee (~$1,500 for a corporation, half that for a B Corp, or ENGO. $100. for a registered charity.) The fee is a one time payment for use of the Clean50 logo and entitles the organization to self-identify as a winner in perpetuity,

Do you understand about the licence?*

YES - we accept we must execute a license if we win.
No - please ignore our submission

IF you have questions by all means call us to discuss - Gavin @ 416-925-2005 x 2300

How did you hear about the Clean50 Awards?*

Should we add the email addresses above to our Clean50 mailing list?*

Yes - both
Yes - but just the first one
Yes - but just the second one
No - neither

Are you happy with all your answers? Don't answer the question unless you're done!*

Yes! I'm done - click and then "submit"

This is the end of the form - if you need to edit, now is your last chance to go back!

VCIB Community Champion Submission Form