Cover page – please remove before submitting your application

Instructions

  1. You must complete this formto applyto the Fuel Poverty Support Fund
  2. Please submit your application via email to ll all sections completed, including signing the funding declaration (Question 1d)
  3. Applications must be submitted and received at or before5pm on 10 January 2018.
  4. You can find out more in the Fuel Poverty Support Fund Prospectus.

NB: Please note that decisions to grant funding (if any) are subject to a formal decision making process. You must not place any reliance whatsoever on the support of the GLA until formally notified in writing and youhave executed and returned a funding agreement with which you will be provided by the GLA should your application prove successful.

Accordingly, any expenditure that you incur and/or to which you commit (including that which you have incurred or committed to in relation to the preparation of your proposal for funding) prior to formal notification and execution and return of the funding agreement is incurred and/or committed entirely at your own risk.

  1. If you want to discuss your funding application, please contact:

John Kolm-Murray
Principal Policy & Programme Officer
020 7983 4451
/ George Simms
Principal Policy & Programme Officer
07900 152014

Fuel Poverty Support Fund: Funding Application

Organisation information

Please complete the form below

Organisation Name
Organisation address
Are you related to or have any contact with any elected GLA officials or members of our staff? If so, please tell us about your relationship and theirname/names and theteam they work in

Question 1: Pass/fail requirements

NB: If you do not complete all the following field your application may not be considered

Question 1a: Project manager

Please provide details of the person who will oversee day-to-day delivery of your pilot projects if your application is successful. This should be a relevant local authority officer.

Project manager name
Job title
E-mail address
Telephone

Question 1b: Project sponsor

Please provide details of the person who will be your project sponsor if your funding application is successful. This should be a senior officer within your local authority.

Project sponsor name
Job title
E-mail address
Telephone

Question 1c: Essential criteria

All applicants must meet these criteria. Bids will not be considered otherwise.

Criteria / Please tick
We confirm that the proposed activities will be completed by 31st March 2019
We propose to expand an established service in London, either to reach a greater number of households or to cover a wider area, for example through partnering with other local authorities (please provide details in response to questions 2a and 2b)/
We confirm that the funding will be used to deliver additional service, and not as substitute funding for existing work.
We propose to deliver funded activities solely within London

Question 1d: Funding Declaration

Please complete and sign the Funding Declaration included in the funding application form below. This mustbe signed by the project sponsor, scanned and returned with your funding application.

Funding declaration

By signing this funding declaration, weacknowledge and agree that:

  1. You(the GLA) will use this application form and the other information we give to you to:
  • evaluate your application for funding and decide whether any funding may be awarded to us;
  • provide copies to other individuals or organisations who are helping you to evaluate our application and monitor your use of any funding awarded and progress in the delivery of funded projects; After we reach a decision, we may also tell them theoutcome of your application and, if appropriate, why we did not offeryou support
  • hold in your database and use for statistical purposes;
  1. if you offer usfunding, you will publish information about us relating to theactivity you fund, including (without limitation) the amount of funding and the activity itwas for. This information may appear in our press releases, in our print and onlinepublications and in the publications or websites of any partner organisations whohave funded the activity with us;
  2. we have read the GLA data protection and freedom of information policies andaccept how we generally plan to treat your application and other relatedinformation if someone asks to see it under the Freedom of InformationAct 2000;

Tick this box if you consider that we should treat your proposal as confidential
information
Tick this box if you consider that we should treat your financial information, suchas your budget and any business plan, as confidential information
Tick this box if there is any other information you have provided that youconsider to be confidential information. You must tell us what that information isand give us your reasons below or in a separate letter. If you are sending us aseparate letter, please write ‘letter included’ below

NB:As indicated above the GLA is subject to the Freedom of Information Act 2000 and also the Transparency Commitment (see clause [ ] of the attached grant agreement)

  1. wewill work with the GLA to achieve the project objectives and timescales set out in sections 2-4 of the Funding Prospectus. This includes sharing any tender documents, contracts and monitoring data required for evaluation to support roll out of future phases of the London Fuel Poverty Support Fund Project;
  2. we have read and understood the attached grant agreement and confirm our acceptance of the same; and

To the best of my knowledge, I confirm that the information supplied on this form iscorrect and complete. If successful, this organisation will use the funding only for thepurpose shown in this application, accepts and comply fully with all of the provisions of theattached grant agreement (which will be populated by the GLA and provided to you for execution as a deed).

Signed:

Name (please print):

Position:

Organisation:

Date:

Question 2: Quality requirements

Question 2a – Experience

Please provide details of your experience in running a fuel poverty advice and referral service. We particularly want to hear about delivering home energy visits, fuel debt alleviation support, assessing for individual grant eligibility and recruiting partners across a range of sectors,

Question 2b – Project management

Please tell us howyou plan to resource and manage the expansion of your existing advice and referral programme to meet our requirements and reach our target groups. Please detail any ECO Flex arrangements. We also want details of the team involved in the bid and your partnership working.

Question 2c – Project outcomes

Please provide details of the following:

How many residents you aim to support overall

How many home energy visits you plan to carry out

How many fuel debt cases you propose to support

How many benefit entitlement checks you propose to enable or deliver

How many households you propose to refer to the Mayor’s fuel poverty support scheme or other schemes such as ECO

How many vulnerable households you aim to add to Priority Services Registers

How many new partner organisations you propose to recruit

Show how the funding will lead to outcomes that would not have taken place with your existing funding

Question 2d – Project plan

Please provide an outline project plan setting out the delivery milestones showing how you will reach the numbers set out in your response to question 2c

Action / Date / Responsibility – if delivering as part of a consortium

Question 2e – Additionality

Please set out what additional benefits you believe your scheme can deliver

Question 2f – Maximising impact

Please provide details of how you will review the scheme as it progresses, as well as how you intend to capture and share lessons learned

Question 3 – Costings

Please provide a breakdown of your costs below:

Item / Number of clients / Cost
Unique referrals received and processed (labour)
Unique home energy visits carried out (labour)
Home energy visits measure costs / As above
Unique energy debt alleviation cases (labour)
Referrer engagement
Telephone and postage costs
Marketing
Travel
Fixed overheads (accommodation, senior management etc)
Other costs

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