Please provide a story (up to 500 words with at least one photo) about your congregation s journey towards sustainability:

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1 Five Leaf Eco-Awards Assessment of Church Submission Form Candidate Church: Criteria submitted for: Submitted by: Date Submitted: Assessment Against Criteria: Basic Certificate Note: The Basic Certificate must be completed before the advanced leaf awards can be attempted. Requirement Action Completed Completion of an energy audit Take three actions to reduce your energy or resource use Run two behavior change campaigns (encouraging the congregation to use the church building more sustainably) Environment themed worship service Two resources provided to help the members of the congregation to be greener at home Environmental event/outreach held Special project (that demonstrates your dedication to the environment) Please provide a story (up to 500 words with at least one photo) about your congregation s journey towards sustainability: (These photos and story will be used on the fiveleafecoawards.org website and in press releases about your Five Leaf Eco-Award.) Basic Certificate achieved:

2 Eco-Worship Leaf Award Information Required Orders of service for at least four worship services with environmental themes and the dates they were given. Proof of participation in the Season of Creation or equivalent Proof of two in depth Bible studies conducted on environmental themes Proof of two guest speaker events on environmental themes and integration of environmental themes in worship. Eco-Worship Leaf Award achieved: Advanced Leaf Awards Eco-Church Building Leaf Award Requirement Action Compl eted Additional Information Required Conduct a detailed energy audit of your property 30% reduction in electricity use 20% reduction in water use

3 10% reduction in gas use 40% reduction in the volume of waste Switch all paper based items to recycled brands with the highest postconsumer content available Conduct four behavior change campaigns \ Eco-Church Building Leaf Award achieved: Eco-Congregation Leaf Award information required At least 40% of the congregation has switched to GreenPower or renewable energy sources for their homes Evidence the congregation is sharing resources such as food or possessions The congregation is committed to reducing the impact of their travel to and from the church

4 Evidence that the congregation has committed to ethical consumption and production practices Eco-Congregation Leaf Award achieved: Eco-Outreach Leaf Award Information required Evidence you have made your outreach programs as environmentally friendly as possible A report outlining your environmentally friendly outreach program and discussing what it hopes to achieve, as well as what progress has been made so far. Eco-Outreach Leaf Award achieved:

5 The Five Leaf Award Note: All other awards in the program must have been achieved before attempting this award Requirement Action Compl eted Additional Information required Order of Service for at least four ecosermons and four eco-bible studies A photo of the eco-library Evidence of 60% of the congregation using GreenPower or renewable energy. Evidence of effort to make travel more environmentally friendly Submit resources or information on events used to help the congregation reduce their impact Evidence of the purchase of ethical products by the congregation and a system of possession sharing/recycling Local produce policy Copy of Fair Trade Faith Group certificate or equivalent Reports on two additional established environmental outreach programs Evidence of assistance to other religious institutions Impact on the community can be demonstrated by stories in local papers, public events and statements by members of the community A report on the church s plans going forward to improve their environmental performance. Completion of the Five Leaf Eco-Awards Final Survey The Five Leaf Award achieved: Summary of Report: