Page 1 of 2

Community Sponsorship Program

Prior to filling out this form, please check the guidelines for applicant and project eligibility criteria in our Early Community Sponsorship Guidelines

Application Form

Overview of the initiative

01. Name of the initiative:

02. Provide a short overview of your initiative (further detail will be requested in the following sections):

This field has a limit of 300 characters

03. Total sponsorship funding for the application:

04. Timing of the initiative:

About your organisation

05. Organisation Name

06. ABN/ACN

07. Length of time the organisation has been operating:

Note: The organisation must have been operating for at least 12 months at the date of the application.

08. Provide a short overview of your organisation:

This field has a limit of 300 characters

09. Which category best describes your organisation:

Contact information

10. Contact Name

11. Address:

12. Email

13. Phone Number

Preferred method of contact

Note, applicants will be notified by email of the outcome of the funding round

About the initiative

14. Location of the initiative / Distance of the funding initiative from the Pines Wind Farm investigation area?

15. Which category best describes your initiative:

Education and Training

Community Development

Health and Wellbeing

Environment

Economic Development

16. Describe how the initiative will benefit the local community:

17. Describe how the initiative will benefit the broader community beyond the organisation/program being funded:

18. Please provide a breakdown of how the requested funds will be spent

Upload a copy of your quote or cost estimate if available

Declaration and submission

Declaration and undertaking to TagEnergy Australia Investments 5 Pty Ltd and Stromlo Energy Australia Pty Ltd, together The Pines Wind Farm:

I/we the person(s) making this declaration on behalf of the organisation named in this application, warrant that the information contained in this application is true and correct to the best of my/our knowledge, information and belief.

Signature