MTSU Clean Energy Initiatives Project Funding Request

Form to be used to submit request online.


1. Requestor information
List the name of the person responsible for submitting the application, the department, and contact information.
Name of Person Submitting Request
Department/Office
MTSU Box #
Phone # (Office)
Phone # (Cell)
E-mail

 

 

 

 

 

 

 

2. Project Categories (Select One)
Select the category that best describes the project.
Energy Conservation/Efficiency
Alternative Fuels
Renewable Energy
Sustainable Design
Other  

 

 

 

 

 

 

 

 

3. Project Information

a. Please provide a descriptive title for the project.

b. The project cost estimate is the expected cost of the project to be considered by the committee for approval, which may differ from the total project cost in the case of matching funding opportunities. Any funding request is a ‘not-to-exceed’ amount. Any proposed expenditure above the requested amount will require a resubmission.

c. Provide a statement as to the source of any project cost estimates.

d. The submittal date is the date the form is submitted for consideration.

a. Project Title
b. Project Cost Estimate
c. Source of Estimate
d. Submittal Date

 

 

 

 

 

 

 

 

4. Project Description  
(Must be completed in detail.)

a. The scope of the work to be accomplished is a detailed description of the project.

b. The benefit statement must detail the advantages of the project as relates to the selected project category.

c. The location of the project requires the name of the building, department, and/or specific location of where the project will be conducted on campus.

d. All participants, reviewers, and/or approvers must be listed describing their role involved in the project work. A detailed list of names and roles may be attached to the form when submitted in order to provide the information required.

e. Provide information clearly stating future operating and/or maintenance requirements occurring as part of the proposed project.

f. Provide a statement of how the project can improve the environment.

g. Provide any additional comments or information that may be pertinent to approval of the project funding request

 

 
a. Scope: Work to be accomplished

 

 
b. Scope: Benefit Statement

 

 

 

 

 

 

c. Location of Project (Building, etc.)

 

 
d. Participants and Roles

 

 
e. Future Operating and/or Maintenance Requirements

 

 
f. Environmental Justification

 

 
g. Additional Comments or Information Pertinent to the Proposed Project

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Project Performance Information

a. Provide information on estimated annual energy savings stated in units such as kW, kWh, Btu, gallons, etc.

b. Provide information on estimated annual energy cost savings in monetary terms.

c. Provide information on any annual operating or other cost savings in monetary terms. Be specific.

d. Provide information about any matching or supplementary funding opportunities that are available. Identify all sources and explain.

 

a. Estimated Annual Energy Savings (Estimated in kW, kWh, Btu, etc.)

 

b. Annual Energy COST Savings ($)

 

c. Annual Operating or Other Cost Savings. Specify. ($)

 

d. Matching or Supplementary Funding (Identify and Explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After completion of all five (5) sections, submit.

 


   Center for Energy Efficiency | MTSU Box 57 | Murfreesboro, TN 37132
Phone 615-904-8096 | Fax 615-904-8093 | e-mail
cee@mtsu.edu

MTSU is a Tennessee Board of Regents Institution. MTSU is an equal opportunity, non-racially identifiable, educational institution that does not discriminate against individuals with disabilities.