E.ON Energy Action Fund Application Form

Please complete all sections of the form and email to [email protected]

Section One - Contact Details

Organisation Name Contact Name Address Phone Number Email address

Overview of organisation (max 100 words):

Section Two - Your Application (in detail)

Amount requested: £______(from £50 to £2,000)

2.1 Project description (max 300 words)

Provide a description of the project and details of what the funding will be used for. What is your project aim? (Including the proposed equipment/services, how you decided what was right for your project/organisation) 2.2 Project implementation and management (max 300 words)

How will your project be implemented? (Including how the project will be managed.)

2.3 Timescales

Indicate the timescales you are working to for your project.

2.4 Costs

Provide a breakdown of costs for your project, clearly indicating how an E.ON Energy Action Fund grant would be allocated and spent.

2.5 Fundraising

Provide details of any other funds allocated to this project, including funds raised through your own fundraising activity, any other grants applied for and/or received. Section Three - Benefits

3.1 Energy Benefits (max 200 words)

Detail the impact the project will have upon energy usage. (Including direct impact and indirect impact through education, awareness and behavioural change.)

3.2 Community Benefits (max 200 words)

Who will benefit from the project? (Including those who will both directly and indirectly come into contact with your project, cost/operational savings, enhanced community facilities and the impact on the profile of your organisation/community.)

Section Four

Declaration:

In submitting this application, I confirm that all of the information supplied is accurate to the best of my knowledge and that I have the full support of the above named organisation to be applying on its behalf.

Please tick to confirm you agree to E.ON’s eligibility criteria

Name ______

On behalf of ______(Organisation Name)

Date ______