Dinawan Energy Hub - Pilot Grant Program Application

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* 1. Contact details: Please provide the contact details for the point of contact for this application

First Name

Last Name

Email

Telephone

Full Address

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* 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

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* 3. Select status of applicant

Individual

Charity/Non-profit/NGO

For Profit

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* 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.

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* 5. Please describe your project (e.g., its core aim(s) and how you intend to use the funding over the 12-month period).

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* 6. Please explain how the project would benefit your local community, including specifying which geographic areas the project will benefit.

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* 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.

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* 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).

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* 9. What is the amount of funding you are requesting for the project?

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* 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)