Dinawan Energy Hub - Pilot Grant Program Application Question Title * 1. Contact details: Please provide the contact details for the point of contact for this application First Name Last Name Email Telephone Full Address Question Title * 2. Business Contact Details: Please provide the contact details of your non-profit and/or company (if applicable) First Name Last Name Email Telephone Registered Business Address ABN/ACN Question Title * 3. Select status of applicant Individual Charity/Non-profit/NGO For Profit Question Title * 4. Please provide information on the organisation, company, non-profit, group, or individual applying for funds. This should include how the organisation was formed, existing funding, the structure of the organisation, as applicable. If an individual is applying, this should include basic information about your presence in the community and if you have experience receiving funding for initiatives. Question Title * 5. Please describe your project (e.g., its core aim(s) and how you intend to use the funding over the 12-month period). Question Title * 6. Please explain how the project would benefit your local community, including specifying which geographic areas the project will benefit. Question Title * 7. Please explain how your project supports one or more of the nine funding priorities listed on the Dinawan Energy Hub Pilot Grant Program webpage. Question Title * 8. Please explain what success would look like for your project and outline how you will measure the progress of your project (e.g., provide any metrics or milestones to demonstrate the use of funding, how you will monitor and evaluate the impact of your project to support your local community and funding criteria). Question Title * 9. What is the amount of funding you are requesting for the project? Question Title * 10. Please read and complete the following declaration.This declaration must be completed by an authorised representative of the applicant (or, if this application is a joint/consortium application, authorised representative of the lead organisation). The authorised representative should be a person who is legally empowered to enter into contracts and commitments on behalf of the applicant.I declare that:• I confirm the information provided in this application is true and correct. • I confirm I have the authority to make this declaration on behalf of the applicant.• I give consent to Spark Renewables to make public the details of the applicant and the funding received, should this application be successful. Name of Authorised Officer (Applicant name if individual is applying) Position of Applicant (“Self” if individual is applying) Digital Signature (By writing your name) Submit Application