AmplifyMass
Pre-Qualification Application for ARPA-E Matching Funds Program
Department of Energy (DOE)
Funding Opportunity
Announcement (FOA)
Number and Name
Project Title
Principal Investigator (PI)
PI Research Institution or
Company Name
Address
Contact E-mail and Phone
Number
Proposed Total Project
Budget (including cost share)
Total Cost Share Requirement
Amount Requested from
MassCEC1
Technology Category
(check all that apply)
Energy efficiency
Demand response
Energy conservation
Solar power
Wind power
Geothermal
Wave and tidal energy
Advanced hydropower
Energy storage
Biofuels
Renewable, biodegradable
chemicals
Advanced thermal-to-energy
conversion
Hydrogen
Fuel cells
Carbon capture/sequestration
Energy monitoring
Green building materials
Energy-efficient lighting
Gasification and conversion to
liquid fuels
Demand-side management
Combined heat and power
Other technology powered by the
sun, wind, water, biomass,
alcohol, wood, fuel cells, or any
renewable, non-depletable or
recyclable fuel
Other
[insert description here]
Note that coal, oil, natural gas (except when used in fuel cells or combined heat
and power), and nuclear power are not eligible for AmplifyMass awards.
1
If a university applicant, this amount may not exceed the lesser of 5% of the total project budget or $100,000. If a
company applicant, this amount may not exceed the lesser of 10% of the total project budget or $300,000.
[PI Last Name]
Date of Application: [MM-DD-YYYY]
For Company Applicants Only
Number of Full-Time
Equivalent Employees
Sources and Amount of
Funding to Date
Revenue History (by year)
Location(s) of all company
operations.
Technology Overview (200 words or less)
 Description of the technology and its stage of development
 Application(s) and problem(s) it solves
 Description of the intellectual property, if applicable
Commercialization Potential (200 words or less)
 Target market(s) for the technology, market size(s), and growth trajectory
 Proposed business model
 Go-to-market strategy
Information on ARPA-E Partner Research Institutions or Companies (if applicable)
 Names, brief descriptions, and locations of each Partner
 Project role of each Partner
 Breakdown of project budget allocated to each Partner
Required Attachments
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ARPA-E Concept Paper
ARPA-E Response to Concept Paper
Resumes of team members
Authorized Applicant’s Signature and Acceptance Statement (attached below)
Notice of Confidential Information Cover Letter2
Applications should be submitted via e-mail to amplifymass@masscec.com with the subject line
“AmplifyMass Pre-Qualification Application – [Research Institution or Company Name].”
2
Only include if any confidential information has been submitted with this application.
[PI Last Name]
Date of Application: [MM-DD-YYYY]
QUESTIONS?
MassCEC AmplifyMass Awards
Program Manager: Alison Ernst
Massachusetts Clean Energy Center
63 Franklin Street, 3rd Floor, Boston, MA 02110
Phone: 617-315-9389 Email: amplifymass@masscec.com
[PI Last Name]
Date of Application: [MM-DD-YYYY]
AmplifyMass
Authorized Applicant’s Signature and Acceptance Statement
The undersigned is a duly authorized representative of the Applicant listed below. The Applicant has read and
understands the Program requirements as outlined in the AmplifyMass Solicitation for Applications (the
“Solicitation”). The Applicant acknowledges that all of the terms and conditions of the Solicitation are
mandatory.
The Applicant specifically acknowledges the application of the procedures regarding submission of sensitive
information as set forth in the Solicitation, and specifically agrees that it shall be bound by those procedures.
The Applicant understands that all materials submitted as part of this Pre-Qualification Application (the
“Application”) are subject to disclosure under the Massachusetts Public Records Law, codified at Chapter 66 of
the Massachusetts General Laws, unless exempt from public disclosure under a statutory or common law
exemption, including the limited exemption at Massachusetts General Laws Chapter 23J, Section 2(k) regarding
confidential information submitted to MassCEC by an applicant for any form of assistance.
Applicant acknowledges and agrees that MassCEC has no obligation, and retains the sole discretion to fund or
choose not to fund the Application set forth herein, and that MassCEC’s receipt of the Application does not
imply any promise of funding at any time.
I certify that the statements made in this Application, including all attachments and exhibits, are true and
correct to the best of my knowledge.
AUTHORIZED SIGNATORY: ____________________________________________________________________
Print Name: _____________________________
Title: ___________________________________
Date: ___________________________________
[PI Last Name]
Date of Application: [MM-DD-YYYY]