<p>E.ON Energy Action Fund Application Form</p><p>Please complete all sections of the form and email to [email protected]</p><p>Section One - Contact Details</p><p>Organisation Name Contact Name Address Phone Number Email address</p><p>Overview of organisation (max 100 words):</p><p>Section Two - Your Application (in detail)</p><p>Amount requested: £______(from £50 to £2,000)</p><p>2.1 Project description (max 300 words)</p><p>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)</p><p>How will your project be implemented? (Including how the project will be managed.)</p><p>2.3 Timescales </p><p>Indicate the timescales you are working to for your project.</p><p>2.4 Costs </p><p>Provide a breakdown of costs for your project, clearly indicating how an E.ON Energy Action Fund grant would be allocated and spent.</p><p>2.5 Fundraising </p><p>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</p><p>3.1 Energy Benefits (max 200 words)</p><p>Detail the impact the project will have upon energy usage. (Including direct impact and indirect impact through education, awareness and behavioural change.)</p><p>3.2 Community Benefits (max 200 words)</p><p>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.)</p><p>Section Four</p><p>Declaration:</p><p>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.</p><p>Please tick to confirm you agree to E.ON’s eligibility criteria</p><p>Name ______</p><p>On behalf of ______(Organisation Name)</p><p>Date ______</p>