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| Project Name: | (Name that is Commonly Agreed to) |
|---|---|
| Primary Proponent: | (Organization/Community Submitting the Request) |
| Community: | (Name of Community) |
| Region: | (Province/Territory of Canada) |
| Project Focus: | (Type of Energy Efficiency and/or Renewable Energy Focus) |
| Key Contact: | (Name of the Person/s) |
| Title/Affiliation: | (Title/Organization of the Key Contact) |
| Contact Coordinates: | (Address, Phone, Fax, Email of Key Contact) |
| Community Head: | (Name & Coordinates of Head Elected Community Leader) |
| References: | |
| (Local/Regional References, with Coordinates, Who are Familiar with the Project and Can Provide Background: Community Leaders/Elders, Local Utility, Community Partners, INAC Regional Office Contact) | |
| Project Description: | |
Estimated Length: 1 Page |
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| Project Partnership: | |
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| Explanation of Current Energy Generation & Consumption Patterns: | |
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| Planned Energy Efficiency/Renewable Energy Approach: | |
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| Summary of Energy Efficiency & Renewable Technologies to be Used | |
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| Estimate of Greenhouse Gas Reductions Achieved Directly Through the Project: | |
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| Project Budget | |
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| Documentation of Other Project Benefits: | |
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| Submitter Comments: | |
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*Note: All submissions will be kept confidential
Appendix A
Budget Table 1
Detailed Budget Information for INAC's Clean Energy Initiative Project Funding
| Class of Expenditures* (fill in classes as applicable) |
Previous Year 2006-2007 (if applicable) |
Current Year 2007-2008 |
|---|---|---|
| 1. Salaries and Wages | ||
| 2. Equipment and Facilities | ||
| 3. Travel | ||
| 4. Professional Fees (i.e. contracts) | ||
| 5. Operating Costs (i.e. supplies, publications, phone, fax, mail, administration fee) |
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| 6. Other Costs (must specify) | ||
| TOTAL COSTS |
NOTE: One form must be completed for each proposal submitted.
* See the attachment “Description of Each Class of Expenditure” for more detailed information.
Budget Table 2
Detailed Budget Project Information
| Class of Expenditures* (fill in classes as applicable) |
Previous Year 2006-2007 (if applicable) |
Current Year 2007-2008 |
|---|---|---|
| 1. Recipient Support (including in-kind) |
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a) Salaries |
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b) Equipment and Facilities |
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c) Operating Funds |
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| 2. Other Project Funding Sources (Specify as much detail as possible) |
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a) Financing |
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b) Investors/Partners |
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c) Other |
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| Total Estimated Costs for Recipient Support And Other Project Funding Sources (#1 and #2 above) | ||
| Total INAC Clean Energy Initiative Funding Requested (from Table 1) | ||
| GRAND TOTAL PROJECT COSTS | ||
NOTE: One form must be completed for each proposal submitted.
* See the attachment "Description of Each Class of Expenditure" for more detailed information.
Proposals submitted to INAC's Clean Energy Initiative funding should include the following level of budget detail and indicate multi-year funding as applicable:
Recipient Support
Other Project Funding Sources