Waipipi Wind Farm community fund Funding report back form We’re proud of the part that the Waipipi Wind Farm Community Fund has played in supporting your project or mahi. We want to know more about what you’re doing and how your funding application benefited the local community. Your story might become part of our story: what we tell your community, our teams, and wider via social and traditional media. If your application is successful and you accept the grant, please complete this form within two months of the completion date you proposed within your application. The contents of this form may be used in promotional material to tell this story. We may collect any personal information included in this form, or provided by you in relation to the project, in order to promote the story of your funding. If you apply for further funding from the Community Fund, we might take a look back at this report to look at how you spent the money last time. You can access or correct any personal information by contacting us at WaipipiWindFarmCommunityFund@mercury.co.nz
Remind us about what you’re doing Applicant / Project name Contact person Phone Email Amount of grant:
We’d love to see what you’ve achieved If possible, please email us with photos of your completed project / initiative. Email us at WaipipiWindFarmCommunityFund@mercury.co.nz Please provide your consent here for their use: _____________________________________
Tell us more about your project and its outcomes: Please provide a short summary of your project/initiative and how the money that the Fund provided was spent. (use additional pages if required)
How has this project benefited the community? Please provide the details of how the funding was spent and the benefits your community received from this project. (attach additional pages as required)
I agree to participate in any publicity generated by Mercury (or Mercury’s marketing partners), and to the use of the applicant’s name, project that the grant has been awarded for and photos of the finished product for promotional purposes. I Certify that the information concerning this Report Back Form is true and correct and in-line with the funding guidelines. Name: Signed: Date: Please retain the original for your records and send a scan or clear photograph of this application form to: WaipipiWindFarmCommunityFund@mercury.co.nz
For more information, contact the Waipipi Wind Farm Community Fund Committee: WaipipiWindFarmCommunityFund@mercury.co.nz Learn more about the Wind Farm Community Fund here: https://www.mercury.co.nz/why-mercury/renewable-energy/windgeneration/waipipi-wind-farm-community-fund