FY24 EmPower Massachusetts Implementation Application Form

First Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Second Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Third Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Fourth Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Fifth Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Sixth Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Seventh Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Eighth Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

Ninth Partner
Organization or Individual Name*
Type of Organization*

Non-profit Community-Based Entity/OrganizationOther Non-profit Entity/OrganizationFederal and/or State Recognized TribePublic entity, such as municipalities, municipal light plants, and regional planning agencyFor-Profit Entities including: clean energy installers, energy efficiency, or home performance contractors, technical or workforce training organizations, financial institutions, or other clean energy practitionersIndividualOther (Please Clarify)
Contact Person (if different than above)

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.

10+ Partners
If you have more than 9 partners. please include additional partners' information below.

Grant Funding Proposal (i.e. Proposed Approach)

Please answer the following questions. Brief responses are encouraged. PLEASE NOTE: if you are applying under the Energy Coach/Ambassador or Technical Assistance Provider track, please review Section 5.2 of the EmPower FY24 Implementation RFP and be sure to address the requirements described there in your answers on this page. If applying for one of these tracks, you will get the opportunity to clarify your proposed budget later on.
Provide a Project/Program Title:*
Provide a 2-3 sentence summary of your proposed Project or Program. Think of this as your “elevator pitch”.*

0/100
Based on the above, what will the requested funding specifically be used for? For example, "we will use our funding to hire part-time staff to conduct outreach in a priority group neighborhood".*

0/200
What is the Priority Group you are seeking to benefit and how will they benefit? Please include whether your proposal would target a geographic community (i.e. City/Town, neighborhood) or non-geographically based community (i.e. affinity group, religious network, shared language community).*
What are the specific goals or targeted outcomes expected from the implementation of your proposed program model or project? For example, "program team anticipates we will successfully facilitate the sign up of 50 households to a shared solar project, through which households will save 20% on their utility bill".*

0/200
What activities, such as research or stakeholder engagement, have been completed in preparation for the implementation of this program model or project? For example, "we have conducted 3 community meetings or focus groups to identify community interest in a weatherization campaign. If no stakeholder engagement has occurred, please clarify reasoning".*

0/200
(If Applicable) If this is a follow-on funding request for a previously awarded project under EmPower, please clarify the following:

Please answer the following questions. Brief responses are encouraged.
How does this follow-on funding support the evolution of your program model or project in a significant or impactful way?

0/200
What, if any, changes have been made to the design of the program to incorporate lessons learned and/or to shift focus or expand the impact of your program model or project?

0/200

Proposed Timeline and Outcomes
With as much detail as currently available, please clarify your expected timeline for the usage of this funding an all proposed outcomes of the funding. Please note that funding should be utilized within 3 years. Be sure to tie in all activities proposed in the previous section about your proposal.*
Based on your specific goals or targeted outcomes, what would you propose to submit to MassCEC to show completion of the tasks supported by this funding? Possible examples include: metrics of clean energy systems contracted, number of people reached, number of events hosted. If selected this will be used to draft your project scope of work and milestones for payment. See example scope of work in template contract (Attachment 3). *

Proposed Budget
Proposed funding usage breakout: Please fill out the table below with each activity and proposed amount of funding associated with completing that activity. If there are multiple team members that will receive funding, please list which team member will ultimately receive funds for each budget item. Note: MassCEC will pay all awarded funding directly to the Lead Applicant and the Lead Applicant can disburse the funding to other team members, so be sure to clarify exactly who will receive which funds.

Budget*

	Proposed activity (e.g. funding staff time & supplies for community outreach)	Team member receiving funds for each proposed activity (e.g., the lead applicant or a specific project partner)	Funding amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Total Budget Request (up to $150,000)
In-kind technical services from MassCEC: Depending on the type of program applicants propose, and upon request, MassCEC may offer in-kind support instead of all or part of a cash grant. Are the Applicants interested in any in-kind technical services from MassCEC instead of all or part of a cast grant? Please respond below, and also contact MassCEC to discuss your interests/needs prior to applying.*

NoYes, please elaborate:
Grant Payments: Applicants will receive a portion of the funding upfront and will receive the remainder once part or all of the project is completed. How would you like to receive the rest of the funds?*

In one payment when the tasks supported by this funding are completed.In multiple payments, based on the completion of milestones/other (if you would like to receive multiple payments, please elaborate on how you would prefer to receive the remainder of the funds):
Non-MassCEC Funding (if applicable): Describe any other sources of support (name of grant, organization providing grant) for this proposed work, including in-kind work. When possible, please provide value of funding. (Note: no additional sources of funding are required to apply for this funding.)
Would you like to request up to $300,000 in funding for your proposed idea?

Please note: only a limited number of project/program proposals that qualify under either the Energy Coach/Ambassador or Technical Assistance Provider Tracks will be funded past $150,000, and applications will be considered on a case-by-case basis. Please review the EmPower FY24 Implementation Grant Request for Proposals on the EmPower website to learn more about these tracks, and if you believe that you are eligible, please select yes below and continue to submitting a second proposed budget on the next page.
I would like to submit an alternate proposed budget for up to $300,000. (If you select yes, you will be prompted to provide an alternate budget and more information on the next page.)*

YesNo

Proposed Budget up to $300,000 (Priority Tracks Only)
Narrative Requesting Additional Funds: Please describe how additional funds would amplify the outcomes of the proposed Implementation grant.

0/200
New Track Attestations - Select all that apply:

This application is to the Energy Coach/Ambassador Track.This application is to the Technical Assistance Provider Track.In Section 3 of this application form, we have addressed all of the requirements to be considered for additional funding, as outlined in Section 5.2 of the EmPower FY24 Implementation RFP.We agree to work with MassCEC to define deliverables best suited for assessing the proposed model.
Proposed funding usage breakout: Please fill out the table below with each activity and proposed amount of funding associated with completing that activity. If there are multiple team members that will receive funding, please list which team member will ultimately receive funds for each budget item. Note: MassCEC will pay all awarded funding directly to the Lead Applicant and the Lead Applicant can disburse the funding to other team members, so be sure to clarify exactly who will receive which funds.
*Please be sure the total of the funding amount table below is the total amount requested and not an additional amount, e.g. it is $300,000 if that is the total amount being requested instead of a separate $150,000 to be added to $150,000 from the previous page.

Budget (Up to $300,000 scenario)

	Proposed activity (e.g. funding staff time & supplies for community outreach)	Team member receiving funds for each proposed activity (e.g., the lead applicant or a specific project partner)	Funding amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Total Budget Request (Up to $300,000)
In-kind technical services from MassCEC: Depending on the type of program applicants propose, and upon request, MassCEC may offer in-kind support instead of all or part of a cash grant. Are the Applicants interested in any in-kind technical services from MassCEC instead of all or part of a cast grant? Please respond below, and also contact MassCEC to discuss your interests/needs prior to applying.

NoYes, please elaborate:
Grant Payments: Applicants will receive a portion of the funding upfront and will receive the remainder once part or all of the project is completed. How would you like to receive the rest of the funds?

In one payment when the tasks supported by this funding are completed.In multiple payments, based on the completion of milestones/other (if you would like to receive multiple payments, please elaborate on how you would prefer to receive the remainder of the funds):

Submission of Attachment 1: EmPower Massachusetts Implementation Signature and Acceptance Form
Please visit the EmPower website here, download and sign Attachment 1 for Implementation Grants, and upload your signed document below.
Upload your signed version of Attachment 1 here. (If you are submitting a draft application and requesting feedback, you can upload a blank document here instead if you wish to wait to upload this form until your final submission.)*

Cancelof
If you have any questions about this document, please contact MassCEC prior to applying: empower@masscec.com

Review of Attachment 3: Sample Grant Agreement & Example Scope of Work and Milestones Table
Please visit the EmPower website here for a sample Implementation grant agreement, scope of work, and project milestones table.
Have you reviewed the sample grant agreement? Specifically, have you reviewed the example scope of work and milestones table? (Required)*

Yes
Are there any changes to this template contract agreement that would be necessary before the Applicant could sign the contract? (Note: MassCEC has limited ability to change our standard legal contract terms. Please note that reviewing and requesting changes to standard legal contract terms, if selected, will impact timelines for contracting.*

NoYes - if so, please elaborate below and/or provide an annotated version of Attachment 3 with your application (upload below if applicable)
(Optional) Upload your annotated version of Attachment 3 here.

Cancelof
If you have any questions about these documents, please contact MassCEC prior to applying: empower@masscec.com
Should be Empty:

	Has SDO Certification	Meets the criteria but has not completed SDO certification
Minority Business Enterprise
Women Business Enterprise
Service-Disabled Veteran Business Enterprise
Veteran Business Enterprise
Lesbian, Gay, Bisexual, and Transgender Business Enterprise
Disability-Owned Business Enterprise

FY24 EmPower Massachusetts Implementation Application Form

Contact Information

First Partner

Second Partner

Third Partner

Fourth Partner

Fifth Partner

Sixth Partner

Seventh Partner

Eighth Partner

Ninth Partner

10+ Partners

Experience & Qualifications

Optional DEI Qualification and Statement

Grant Funding Proposal (i.e. Proposed Approach)

(If Applicable) If this is a follow-on funding request for a previously awarded project under EmPower, please clarify the following:

Proposed Timeline and Outcomes

Proposed Budget

Proposed Budget up to $300,000 (Priority Tracks Only)

Submission of Attachment 1: EmPower Massachusetts Implementation Signature and Acceptance Form

Review of Attachment 3: Sample Grant Agreement & Example Scope of Work and Milestones Table