Ergon Energy
Community Fund
Application Form
Name of organisation/community group
Project title
Short title indicating what your project is e.g. “Tropical Energy Saver Tool Kit”, “Greentown Community Nursery
Project”. For easy reference, please use this name as the file name for your application.
Describe your project
In 300 words or less provide details of your project.
Amount requested? Up to $5,000 excluding GST. $
(excluding GST)
Proposed time frame?
Start Date:
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Projects must commence and be completed within 12 months of receiving a grant.
End Date:
Two of the most important things to us in deciding which projects to support are:
• how your project will benefit the community, and
•why you think it makes sense for us to partner in your project.
So, help us understand your reasoning below.
How will your project benefit the community?
In 200 words or less tell us the project objective/s.
Which communities will benefit from your project?
Tell us the location of the project – the town name/s or area/s e.g. South West Queensland, Burdekin.
NOTE: only projects within the Ergon Energy area of operation are eligible for funding.
Why would you like us to partner with you?
In 200 words or less tell us why we are your preferred partner. Explain how your project will allow us to work with
you to create greater shared value and make your community a better place.
2
How will success be measured?
Tell us in 100 words or less what tangible measures will be used to understand the benefits of the project e.g.
energy savings, number of attendees, etc. Consider the immediate and long-term benefits.
In awarding fund recipients, we also consider how the project may
help us connect with the community.
How will the local community be involved in the project?
Tell us in 50 words or less. Does it only involve your group (who are they) or the wider community?
How will community awareness of the project be raised?
Tell us in 50 words or less. Consider the number of members you communicate with through your normal
communication activities.
Are there opportunities for Ergon to be promoted?
In 50 words or less tell us about any media or social media opportunities or events that we could participate in, or
signage that could be used to recognise our contribution.
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Now we just want a little background to give us the confidence that
the project will run smoothly.
Do you have previous experience in managing community projects or in
using grant monies?
In 100 words or less tell us about your experience with community projects.
Can you think of other supporting information that would be helpful?
In 100 words or less share anything else that will support your application.
Has your organisation/community group ever received an Ergon Envirofund
or Ergon Community Fund grant?
Yes
No
Please provide details of the project budget with a clear breakdown of costs
(excluding GST).
Item
Cost (Ex GST)
$
$
$
$
$
$
$
Total
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$
0
Is this amount full or part funding for the project?
Full funding
Part funding
Where are the remaining funds coming from?
Have these funds been received?
Yes
No
If no, have the funds been formally confirmed
Yes
No
What type of organisation are you?
Not-for-profit community group/charity/organisation/association
Educational institution
Government
Other (please specify):
Please provide your ABN or Certificate of Incorporation Number
ABN Number:
or
No ABN - Certificate of Incorporation Number:
What is your organisation’s GST status?
Registered for GST
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Not registered for GST
Applicant’s declaration
By submitting this application form I, the applicant, declare that:
• the information given here is complete and correct
• I have read and accept the Ergon Energy Community Fund Terms and Conditions.
Name
Position
Organisation
Who will be your contact for the project?
Name
Position
Organisation
Phone No:
Mobile No:
E-mail
Postal Address
Suburb / Town
Postcode
Great! Now all you have to do is:
• save this Application form with a file name that matches your project title
• go to ergon.com.au/communityfund
• up load your Application form via our online Submission form.
Any questions? You can call us on (07) 3851 6318
Or email [email protected]
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