Climate Action Clinic Client Application Form

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Thank you for your interest in being a part of UNH Sustainability Institute’s Climate Action Clinic.

During the Clinic, small teams of UNH students from all majors serve as consultants for organizations, nonprofits, and businesses to help them assess and interpret their organizational carbon footprints as an essential first step toward decarbonization.

Before you start the application, please review program details and the organization expectations.

Note: in order to participate in and benefit from the Clinic, you’ll need to:

· have been in operation for at least 12 months before it starts.

· identify a single primary contact (mentor) for the student team, who will meet with them virtually 1 hour every week, at a time that is mutually available for the mentor and all of the students.

· participate in two additional events (in person or virtually):

1. the program launch (companies will present their project to students in the Clinic to help determine team formation), and

2. the final project presentations/closing showcase.

If you have any questions, please don’t hesitate to send them to alexis.dwyer@unh.edu.

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Organization Name

Website

Organization Mailing Address

Street Address

City

Zip Code

State

Country

Year Company was founded

Current Number of Employees

Please select from the dropdown

Gross Annual Revenue last fiscal year

Input Format - Numbers only

Organization Description

First Name

Last Name

Pronouns

Title

Phone Number

UNH Affiliation

UNH AlumniCommunity PartnerPlease select all that apply

Account Record Type ID

Contact Record Type ID

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Type in the year you are interested in participating then choose the term from the dropdown (SP = Spring, FA = Fall)

If you are unsure or flexible about your participation timing, please choose "Flexible/Unsure"

An organization representative can commit to at least 1 hour per week to the program (to be scheduled based on mutual availability of you and your student team)?

Yes

What do you hope to get out of participation in the Clinic?

Determine our "baseline" carbon footprint to be able to set a reduction goalTrack progress toward our existing reduction goalIdentify the most impactful opportunities for reducing our carbon footprintEngage our stakeholders (employees, customers, investors, trustees, etc.)OtherPlease select all that apply

Other Goals

I have read, and understand, what is expected of a Climate Action Clinic Client, each student team and UNHSI. I am authorized to commit to the Client requirements on behalf of my organization.

Yes

How did you hear about the Clinic?

Event Registration Record Type ID