Power Forward Grant Application

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City or Utility Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Format must be (xxx) xxx-xxxx

Email(Required)

Fax

Contact Person(s)

Amount of Grant Request(Required)

Total Cost of Project(Required)

Total amount already funded / committed by other entities/institutions(Required)

Project Description(Required)

If project is a lighting project, please list the type, quantity and wattage of lights being replaced.

Project Need(Required)

Please describe how your utility or community will benefit from completion of this project. Examples include energy savings, electrification or quality of life.(Required)

Other energy efficiency projects being completed by your utility.

The grant process generally takes 30-60 days. Upon approval and payment of a Power Forward grant, Heartland Energy will provide signage to be displayed at the project site recognizing our contribution to the project.

I acknowledge that all of the information in this grant application is true and correct to the best of my knowledge. (Authorized signature and Title)(Required)

Documentation outlining project costs and specifications of material being purchased must accompany applications. Estimates from contractors or vendors will suffice. Grant applications will NOT be considered until accompanying documentation is submitted. All documentation can be emailed to Ann Hyland at ann@heartlandenergy.com.

Date(Required)

MM slash DD slash YYYY

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