Will/Does your project/facility incorporate energy efficiency measures or need assistance with energy modeling/energy audit? Note: By answering yes to this question, you are applying to NYSERDA's FlexTech Program. LIPA, NYPA, and Municipal Utility customers please view the Scoring Tips.

Project Street Address: Please input the project street address (Street Number and Street Name only).

If the project has multiple locations, please input the primary street address of the project. If the project does not have a definite street address, please input the approximate street address of the project (Street Number and Street Name only).

Project City

Project State

Project county or counties.

Project ZIP Code. (please use ZIP+4 if known)

US Congressional District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

For more than one project location, please provide full address(es) for each location. If Not Applicable, indicate "NA".

Project Latitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Project Longitude (This question's value will be filled automatically, based on the project address, when the application is finalized.)

NYS Assembly District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

NY Senate District where the project is located. (This question's value will be filled automatically, based on the project address, when the application is finalized.)

Type of Applicant (select all that apply)

Is the applicant a DBA?

What is the applicant's DBA name?

Select an applicant ID type from the list below that you normally use to identify your organization on application forms.

Based on your selection from the previous question, enter the associated ID number.

If you are a business, have you been certified as a New York State Minority or Women-owned Business Enterprise (MWBE)?

Organization Legal Name

Applicant First Name

Applicant Last Name

Applicant Street Address

Applicant City

Applicant State

Applicant ZIP Code. (please use ZIP+4 if known)

Applicant Telephone Number (please include area code)

Applicant Email Address

Contact Salutation

Contact First Name

Contact Last Name

Contact Title

Primary Organization

Contact Street Address

Contact City

Contact State

Contact ZIP Code (please use ZIP+4 if known)

Primary Contact Phone Number. (please include area code)

Contact Email

Contract Salutation

Contract First

Contract Last

Contract Title

Authorized Organization

Contract Street

Contract City

Contract State

Contract Zip (please use ZIP+4 if known)

Contract Phone (please include area code)

Contract Email

Additional Salutation

Additional Project Contact First Name

Additional Project Contact Last Name

Additional Contact Title

Additional Organization

Additional Contact Street Address

Additional Contact City

Additional Contact State

Additional Contact ZIP (please use ZIP+4 if known)

Additional Contact Telephone Number (please include area code)

Additional Contact Email Address

Please select the primary sector or characterization that best defines this project.

Please select the secondary sector or characterization that best defines this project.

Project Description. Concisely describe the project, indicating the location, what will be planned, designed, acquired, and/or constructed, the issues/opportunities to be addressed, and expected outcomes and deliverables. Additional details will be collected later in the application process.

Statement of need: Provide a brief summary of the need for the project in the geographic area proposed and the project's financing needs, including funding gaps of the proposed project.

Does the project align with the Regional Economic Development Council's Strategic Plan?

Explain how the project aligns with the Regional Economic Development Council's Strategic Plan.

Current State of Project Development (i.e. planning, preliminary engineering, final design, etc. You may enter N/A for non-project related applications)

Estimated Project Timeline: include project start/completion dates, estimates for design, permitting and construction or other major steps.

Please submit a current and complete utility bill reflecting payment into the System Benefits Charge.

Is the project located in an area affected by a utility company natural gas moratorium?

Please identify the desired assistance. Please view the Scoring Tips for definitions of assistance.

What is the Project Category/Project Type?

If this is a New Construction or Substantial Renovation, please identify the construction type.

Will/Does the project or facility location pay into the System Benefits Charge (SBC)? LIPA, NYPA, and Municipal Utility customers click on Scoring Tips for more information on SBC.

Does the proposed project have planned energy efficiency measures?

Please identify how you were referred

Facility/Building Size (sq. ft.)

Have project measures, equipment, or scope of work been identified?

Have the measures already been installed?

Facility/Building Use

Project Status

Please describe your project timeline.

Estimated Construction Cost/Project Cost/Study Cost ($)

Please indicate the status of ownership

If submitting a CFA on Behalf of – Please enter your company name

If submitting a CFA on Behalf of – Please enter your last name

If submitting a CFA on Behalf of – Please enter your first name

If submitting on behalf of, please provide contact email address

If submitting a CFA on Behalf of – Please enter your title

Electric Utility Company Name

Natural Gas Utility Company Name

If known, please enter the estimated annual kW savings that will be generated through the project.

If known, please enter the estimated annual kWh savings that will be generated through the project.

If known, please enter the estimated annual MMBtu savings that will be generated through the project.

I understand that NYSERDA may require additional project information. (W9, Current Utility Bill, Equipment Specification Sheets, etc.)

By entering your name in the box below, you certify that you are authorized on behalf of the applicant and its governing body to submit this application. You further certify that all of the information contained in this Application and in all statements, data and supporting documents which have been made or furnished for the purpose of receiving assistance for the project described in this application, are true, correct and complete to the best of your knowledge and belief. You acknowledge that offering a written instrument knowing that the written instrument contains a false statement or false information, with the intent to defraud the State or any political subdivision, public authority or public benefit corporation of the State, with the knowledge or belief that it will be filed with or recorded by the State or any political subdivision, public authority or public benefit corporation of the State, constitutes a crime under New York State Law.