1. 1. Entry Form

2. Entry Form Instructions In an effort to streamline the submission process and reduce paper use, the submission process will be entirely electronic. 1.Complete this form and the Project Form. 2.Nomenclature for submission: Project Name-Project Form.ppt 3.Create a zip file that includes the two completed forms and the project’s final GBCI scorecard. 4.Email the zip file to upload.2014_US.u7rczu7are@u.box.comupload.2014_US.u7rczu7are@u.box.com

3. Project Name: Submitting Firm: Firm Role: Submitting Contact Name: Contact Address: Contact Phone: Contact Email: How did you hear about this award program: Entry Form

4. Submission Category – check all that apply by copying and pasting the red check marks above into the appropriate box:  Sustainable Sites  Water Efficiency  Energy & Atmosphere  Materials & Resources  Indoor Environmental Quality  Innovation in Design  Excellence in Water Conservation (Optional)  Project of the Year (Optional) Total Fees included with Submission: $______  Pay Online at www.usgbc-la.orgwww.usgbc-la.org  Pay with check Payable to USGBC-Los Angeles Chapter. Mail checks to USGBC-LA, 550 S. Hope Street, 27th Floor, Los Angeles CA 90071 Attn: Ms. Dominique Smith √√ Entry Form

5. LEED Certification Awarded- Month/Year: LEED Rating System: LEED Certification Level: Entry Form

6. Project Team Members: – Firm Name: – Firm Role: – Contact: – Phone: – Email: Add slides as needed for additional team members Entry Form

7. Project Team Members: – Firm Name: – Firm Role: – Contact: – Phone: – Email: Entry Form

8. Project Team Members: – Firm Name: – Firm Role: – Contact: – Phone: – Email: Entry Form

9. Project Team Members: – Firm Name: – Firm Role: – Contact: – Phone: – Email: Entry Form