Thank you for your interest in participating in NYSERDA's Cooperative (Co-op) Advertising and Training Clean Energy Partners Program.
Please review PON4482 for the full program details and complete eligibility requirements.
You will not be able to save partially completed applications. Be sure to have all the required information (refer to the Program Manual) with you before starting this application. Please provide specific detail demonstrating the anticipated impact, number of leads, and total cost for the proposed activity.
You will receive a tracking number and confirmation on your screen to print or save after you have submitted the application. Refer to this tracking number to check on the status of your application.
Please note: Partially completed information cannot be saved, be sure to have all details with you before beginning the form. For the best form completion experience, use the Google Chrome browser.
If you have any questions, please reach out to Coop@nyserda.ny.gov.
* Required field
Do not submit a Social Security Number to NYSERDA on this form.
If, in accordance with the rules on IRS Form-W9, your taxpayer identification number is a Social Security Number, complete all other information on this form and leave Employer Identification Number blank. In addition to this printed form, mail a printed and signed copy of IRS Form W-9 to NYSERDA, attention: NYSERDA Finance, 17 Columbia Circle, Albany, NY 12203. Include your auto-generated Application Number on this and any forms submitted by mail to NYSERDA. You will receive your Application Number upon submission of your application. Click to view or print the IRS Form W-9.
Contact Name
What technology and/or program is being promoted? (Select all that apply)
Indicate the county(ies) that the co-op activity will be actively promoted in (Select all that apply)
Select the electric utility territories that will be covered by the co-op activity (Select all that apply)
Select the type of media or event(s) that best describes the co-op activity (Select all that apply)
Indicate the type of training you are providing (Select all that apply)
Total cost of the co-op activity before NYSERDAs cost-share
Dollar amount of cost-share you are requesting from NYSERDA (up to a maximum of 50% of the total cost)
Provide any documentation that shows the cost of the activity, such as an estimate or any third-party documentation that outlines the total cost of the proposed activity.
Upload a copy or sample of what is being published, displayed, or advertised. If you are conducting a training, please upload a copy of the curriculum or course outline.
Provide any additional documentation that shows how many people will see/interact with the co-op activity, such as newspaper circulation sheet or number of impressions from a TV commercial or online advertisement.
Upload other related documents
The Participant agrees that by the act of submitting this application, the Participant confirms and agrees to abide the program terms and conditions, the applicable Manual, and with all accepted industry standards, and best practices. This Agreement does not obligate NYSERDA to make any payment to the Participant.
Authorized Signature
Co-op Project Tracking Number
