U.S. Department of Energy

STATE ENERGY PROGRAM

BUDGET EXPLANATION FOR FORMULA GRANTS

1. State / Grant
2. Activity
3. Contact
4. Affiliation
5. Phone
6. E-mail

7. Resource(s) and Source(s)

8. Project Period / / / - / /

9. Partners, participants:

10. Activity Description

11. Status, Impact of Activity

12. Indicate why/how the project was successful

Signed byDate

Typed name

Title

U.S. Department of Energy

STATE ENERGY PROGRAM

SUCCESS STORY

INSTRUCTIONS

The U.S. Department of Energy encourages States to volunteer information about their SEP success stories. This optional Success Story format will help facilitate the reporting of success stories for those States that choose to do so. If States are on-line with WinSAGA, stories can be submitted electronically. Until then, please share success stories with DOE by submitting them in this format to the applicable Regional Support Office with a copy to the Office of State and Community Programs, Office of Energy Efficiency and Renewable Energy, U.S. Department of Energy, EE-42, Room 5E-080, 1000 Independence Avenue, SW, Washington D.C. 20585.

1. Indicate the State submitting the success story, and include the grant number.

2. Indicate the title of the activity.

3. Indicate the preferred person(s) to be contacted for additional information.

4. Indicate the name of the agency with which the contact person(s) is affiliated.

5. Indicate the telephone number of the person(s) to be contacted for additional information.

6. Indicate the E-mail address for the contact person(s).

7. Indicate the type(s) of resource(s) – dollars in-kind, etc., and the specific source of the resource – DOE, State, Utility (including the name of the utility company) etc.

8. Indicate the dates the project was started and completed.

9. List all partners to or participants in the project.

10. Describe the project – whether it is a pilot, training, utility restructuring, etc.; include the location for the project within a State, congressional district, desired outcome(s) or anticipated result. One possible source for this is the SEP Narrative Activity Information Worksheet, Activity Description field.

11. Indicate the status of the project as of the date of submission (Active, Closed, etc.).

12. Indicate why/how the project was successful.

Indicate the name of the person signing the Success Story.

Indicate the date the Success Story was submitted.

Type the name and title of the person signing the Success Story.

Updated (09-02)