EarthTeam
Million Kilowatt Hour Challenge
Student and Teacher/Adult Supervisor Validation Form

IF MORE THAN ONE PROJECT, PLEASE SUBMIT SEPARATE FORMS. STUDENT AND TEACHER SIGNATURES REQUIRED.

STUDENT PORTION

By signing this form I verify that I have completed the following MKHC Action Project:

__MKHC Essay Contest

__Home Energy Audit

__School Energy Audit

__MKHC Poster Blitz

__MKHC Best Poster Contest

__Participation in the Green Business Program

__Other MKHC Action Project (please name _________________________________________________ ).

I understand that the Green Business Program and the MKHC Poster Blitz require validation forms signed by the businesses I visited.

TEACHER / ADULT SUPERVISOR PORTION

By signing this form I verify that the student named below has completed the following MKHC Action Project:

__MKHC Essay Contest

__Home Energy Audit

__School Energy Audit

__MKHC Poster Blitz

__MKHC Best Poster Contest

__Participation in the Green Business Program

__Other MKHC Action Project (please name _________________________________________________ ).

I understand that the Green Business Program and the MKHC Poster Blitz require validation forms signed by the businesses visited.

Student Name (Print) ________________________________________________ Age_________________

Student Signature __________________________________________________ Date ________________

Student Address _______________________________________________________________________

City ___________________________________________________________ Zip__________________

Student E-mail _______________________________________________________________________

Student Phone_______________________________________________________________________

School Name ________________________________________________________________________

School County ______________________________________________________________________

School Address _______________________________________________________________________

City ___________________________________________________________ Zip__________________

Teacher/Adult Supervisor Name ____________________________________________

Teacher E-mail _______________________________________________________________________

Teacher Phone_______________________________________________________________________

Teacher/Adult Supervisor Signature ______________________________________ Date ________________

Return this form to:
MKHC Validation Form
PO Box 4686
Walnut Creek, CA 94956
Fax: (925) 376-1456