NSW Community Renewable Energy Grants Program

Organisations wishing to apply for a Growing Community Energy Grant need to submit an application form.

. Application closing date: 12pm 15 December 2014. Submit to [email protected]

. Successful applicants will be required to work with OEH to develop a detailed project plan, agreed milestones and reporting requirements by

This application form should be read in conjunction with the application guidelines. Copies of these guidelines are available at: Part A: Applicant details

A1. Applicant organisation

Name of organisation:

Postal address:

Suburb:

Is your organisation GST registered? ☐ Yes (click box to select answer) ☐ No

What is the legal status of your organisation?

Note: Your organisation, or administrator, must be legally incorporated to be eligible to lodge an application. If your organisation is not legally incorporated, you must nominate an administrator at A3.

A2. Nominated contact

First name:

Position in organisation:

Phone:

Email:

A3. Administrator This section must be completed if the Applicant is not a legally incorporated entity. Name of organisation:

1 Postal address:

Suburb: Postcode:

Is your organisation GST registered? ☐ Yes If yes, ABN: ☐ No

What is the legal status of your organisation?

A4. How does your organisation and/or project governance function?

Provide details of how your organisation makes decisions, including about the project you are developing. Include the history of the organisation and the number of members you have if you are a membership based organisation.

Part B: Project details (general)

B1. Project title: B2. Project location:

B3. Project summary Provide a summary of your proposed community energy project. Include, particularly, information on: . how the project will be a “community” project; . current status of the project and projected timeframe for completion; and . overall estimated budget of your renewable energy/energy efficiency project.

B4. Community benefit Provide a description of how the community will benefit from the final project outcome. Does the benefit include majority ownership?

B5. Does your project involve …? ☐ Renewable energy generation ☐ Energy efficiency measures ☐ Renewable energy generation and energy efficiency measures

2 B6. What energy efficiency or generation technology is your community renewable energy project expected to use?

Note: Only commercially proven renewable energy and energy efficiency technologies should be considered. If using bioenergy, please attach further details of your proposed technology.

B7. What is the expected generation capacity of your community renewable energy project? kW / MW

Note: Your renewable energy project must be 70kW or greater.

B8. Is your project expected to be connected to a grid? ☐ Yes ☐ No

B9. Is your project to be implemented on a building (owned by ☐ Yes council, community, business) ☐ No

In case of a project to be implemented on a building, have you done any ☐ Yes negotiations with the owners ☐ No

If yes, who

Note: Please attach a letter of support if you have obtained one.

B9. Have you discussed the project with your local council? ☐ Yes ☐ No If yes, which council?

Note: Please attach a letter of support if you have obtained one.

B10. Which OEH Regional Coordinator(s) has your group been in contact with?

Note: You must have been in contact with a Regional Clean Energy Coordinator to be eligible for funding.

Part C: Project details (specific)

C1. Is your project….? ☐ delivering an existing community energy business model in a new context OR ☐ developing a new community energy business model

3 C2. What is the objective of your overall project? Describe your community energy business model. How does the project meet community needs and your regional resource needs or opportunities?

C3. Which project stage/s have you completed? (Refer to guidelines for description of stages) ☐Initiation ☐Social feasibility ☐Technical feasibility

C3. Which project stage/s will you be working through during your grant project? ☐ Social feasibility ☐ Technical feasibility ☐ Planning

C3. What is the specific objective of your grant project? How will you know that you have achieved your grant project objective? How will you measure success?

C4. Financial options What potential options have been identified for funding the project? List any funding sources or grants that have been confirmed? What financial gaps have you identified in your project model and how will you address them over time?

C5. Risk assessment Describe potential difficulties and risks that could hinder the progress of your project and how you intend to manage that risk.

Risk factor How risk will be managed

Part D: Community engagement

4 D1. List any project partner organisations.

Note: Please attach any letters of support you have obtained.

D2. Provide a summary of how the project will leverage existing skills, knowledge and networks in your community.

D3. How will your project engage with your community? What are the project’s key messages?

D4. Will your project involve and/or engage with low income communities? ☐ Yes ☐ No If yes, approximately what portion of the community who will benefit from the project are considered low income? Are any of the low income community members directly involved in this project and in what capacity?

Part E: Proposed use of funding E1. Approximately how much funding $ are you seeking? (ex GST)

Note: You can apply for a grant between $5,000 and $50,000

5 E2. Budget Please provide an indicative breakdown on how the grant would be used? Include any financial or in-kind contribution from partners.

Activity Description Amount (ex GST) Completion date for use of funding

Note 1: Funding must be used by 30 March 2016. All works carried out must be invoiced before that date.

Note 2: Funding will be subject to the negotiation of a funding deed with successful applicants and an agreed project plan including milestones.

Note 3: Funding will be conditional on Applicants granting OEH an appropriate license for OEH to use materials generated as a result of this funding. Applicants will also be obliged to actively provide this material to OEH.

E3. OEH has the discretion to fund projects working on innovative new models up to a grant total of $70,000. Do you wish to be considered for this additional funding?

☐ Yes ☐ No If yes, describe how you would use this additional funding.

Part E: Key personnel in your group

E1. Please list the key personnel in your group that will deliver the grant project Name Job / Function in project Experience / Qualifications

6 E2. How will your project team manage any gaps in technical skills (eg. renewable energy or communication expertise) within the team?

Part F: Declaration and undertakings

I declare that the information given in this application is complete and correct. ☐ Yes ☐ No Name:

If your project has an administrator, please provide authorisation from a senior office bearer of that organisation.

Organisation:

Submission instructions

 Please email the application form as a Word document  Attachments can be emailed as Word, Excel PowerPoint or PDF document format only. [email protected]  Ensure you email your entire application, including all attachments, e.g. maps; CVs.  NB: Emailed applications must not be larger than 10MB including all attachments.