TELL US ABOUT YOUR EV FRIENDLY WORKPLACE!
Organization or Company
*
Your Job Title
*
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have more than one installation to report? (multiple installation dates, multiple street addresses, or both?)
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Yes
No
Tell us about your EV charging installations! Please enter 0 if none of that type of port was installed.
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Date of installation completion
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-
Month
-
Day
Year
Projects completed before April 2022 only eligible for partial recognition
Number of Level 1 ports installed
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Number of Level 2 ports installed
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Number of DC Fast ports installed
*
Workplace size (number of employees)
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10 or fewer
10-25
26-100
101-500
501-1000
1001+
Workplace type
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Private business
Cooperative / Employee-owned business
Non-profit or trade association
Government - Local municipality (ie, city)
Government - County
Government - State agency
Government - Other (such as an air district, COG, etc.)
Government - Federal agency
Tribal entity
Utility (private)
Utility (public)
Utility (co-op)
Other
What is your workplace's Minority Ownership Status? (for definitions, check https://supplierdiversity.iu.edu/classification.shtml)
*
Small business
Women Business Enterprise (WBE)
Minority Business Enterprise (MBE)
Disadvantage Business Enterprise (DBE)
Veteran-owned Small Business (VOSB)
Service-Disabled Veteran-owned Small Business (SDVOSB)
HubZone Small Business
8(a) Small Business
None of the above
Does your workplace have any sustainability certifications already?
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Not yet!
LEED certified
Certified B-Corp
Other
What is your workplace's NAICS code?
I agree to the EMPOWER pledge: "My organization is supporting the growth of charging at work for our employees and pledges to investigate how we can better support employee access to electric vehicles"
I agree
What was the cost to purchase the charging equipment your workplace installed? (optional)
What was the cost to install that charging equipment, such as labor, trenching, etc.?(optional)
Please provide proof of your workplace's EV charging installation. This can be a copy of an invoice for installation costs, photos of installed chargers, or both. We'd prefer to see a copy of an installation invoice if possible.
*
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Clean Cities Coalition Partner
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Central Oklahoma Clean Cities (EMPOWER 1)
Clean Cities Georgia (EMPOWER 2)
Clean Fuels Ohio (EMPOWER 3)
Connecticut SW Area Clean Cities (EMPOWER 4)
Dallas-Fort Worth Clean Cities (EMPOWER 5)
Drive Clean Colorado (EMPOWER 6)
Drive Clean Indiana (EMPOWER 7)
East Bay Clean Cities (EMPOWER 8)
East Tennessee Clean Fuels (EMPOWER 9)
Empire Clean Cities (EMPOWER 10)
Florida Solar Energy Center (EMPOWER 11)
Granite State Clean Cities (EMPOWER 12)
Greater Washington Clean Cities (EMPOWER 13)
Illinois Alliance for Clean Transportation (EMPOWER 14)
Long Beach Clean Cities (EMPOWER 15)
Louisiana Clean Fuels (EMPOWER 16)
Maine Clean Communities (EMPOWER 17)
Michigan Clean Cities (EMPOWER 18)
Minnesota Clean Cities (EMPOWER 19)
New Jersey Clean Cities (EMPOWER 20)
North Dakota Clean Cities (EMPOWER 21)
San Diego Clean Cities (EMPOWER 22)
State of Maryland Clean Cities (EMPOWER 23)
Tulsa Clean Cities (EMPOWER 24)
Utah Clean Cities (EMPOWER 25)
Vermont Clean Cities (EMPOWER 26)
Virginia Clean Cities (EMPOWER 27)
West Virginia Clean Cities (EMPOWER 28)
Wisconsin Clean Cities (EMPOWER 29)
Yellowstone-Teton Clean Cities (EMPOWER 30)
Columbia-Willamette Clean Cities (EMPOWER 31)
Western Washington Clean Cities (EMPOWER 32)
NO COALITION COACH YET
Your local Clean Cities Coalition will contact you about receiving your EV Friendly Workplace Certificate.
Submit for recognition!
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