For office use only
Application #:
Date Received:
Expression of Interest Application Form
Next Generation Energy Storage Technologies
This form is exclusively for the November 2014 AI-EES Next Generation Energy Storage
Technologies call for expressions of interest. For further information about AI-EES, our goals,
and other collaboration opportunities, please visit www.ai-ees.ca.
Instructions:

Complete this application form based on the instructions provided here and in the call
for expressions of interest guidelines document found on www.ai-ees.ca

Note: Do not remove any of the text provided in the template (including the title page)

Email the completed application form in the original Word format (without signature) to
Mark Summers at: mark.summers@albertainnovates.ca

Mail a signed hard copy to:
Mark Summers
Director, Renewable Energy
Alberta Innovates – Energy and Environment Solutions
18th Floor, Phipps-McKinnon Building
1800–10020 101A Ave NW
Edmonton, AB T5J 3G2.
Personal information is collected pursuant to Section 33(c) of the Freedom of Information and
Protection of Privacy Act as it relates directly to and is necessary for the call for proposals.
Should you have any questions about the collection of this information, you may contact Alice
Barr, Director, Strategic Planning and Operations, Alberta Innovates – Energy and Environment
Solutions, Suite 2540, 801 6th Avenue, SW, Calgary, Alberta, Canada T2P 3W2 (403)297-8650.
General Project Information
Project Title:
Project Location(s):
Anticipated Start Date:
Anticipated Completion Date:
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For office use only
Application #:
Date Received:
Applicant Contact Information
Name:
Title:
Company:
Department:
Address:
Phone:
Email:
Section 1: Project Opportunity
Please describe a description of the project opportunity being proposed, including the overall
project objectives and expected outcomes, the proposed scope of work for the project, the
expected advancement over the course of the project, the anticipated next steps after project
completion, and how the technology will advance toward implemented in Alberta, including
anticipated timelines.
(insert text here)
Section 2: Energy Storage Technology
Please provide a complete description of the proposed energy storage technology, including how it
works, how it will be applied, and its known/expected characteristics in terms of its key
performance parameters, including round-trip efficiency, scalability, power and storage capacity,
cycle life, expected capital cost, ramping and charge/discharge characteristics.
(insert text here)
Section 3: Suitability for Alberta
Please describe how well-suited the technology is for deployment in Alberta, including
compatibility with Alberta’s existing electric grid infrastructure, compatibility with Alberta’s
market-based electricity system, compatibility with Alberta’s year-round climate, and any siting
requirements (e.g. geographic or locational constraints).
(insert text here)
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For office use only
Application #:
Date Received:
Section 4: Project Team
Please describe the project team that will carry out the proposed project, including: the key project
team members, their role in the project, and relevant expertise; any additional expertise that will
be needed over the course of the project and in subsequent phases, and how that expertise will be
obtained; and any project partners (both committed and in discussion) and their role in the project.
(insert text here)
Section 5: Project budget and financing
Please provide a budget for the proposed project, indicate how it will be financed, and provide
justification for the funding request. Use the tables provided and add supplementary text below.
Anticipated Project Budget
Personnel (Salaries and Benefits)
Sub-Contracts
Capital Assets/Equipment
Materials and Supplies
Travel
Communication (if applicable)
Overhead (if applicable)
Contingency (if applicable)
Other (describe in text below, if applicable)
$
$
$
$
$
$
$
$
$
Total
$
Project Financing
Source
Amount
Amount Requested from AI-EES
Amount Supplied by the Applicant
Amount Supplied by Government(s) or Other Parties
(please list – add or subtract rows as necessary)
e.g. Government of Alberta
e.g. Government of Canada
$
$
Committed
(Yes/No)
No
-
-
$
$
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Application #:
Date Received:
e.g. STDC
e.g. Party A
e.g. Party B
$
$
$
Total
$
(insert text here)
Signatures and Authorized Representative
By signing as representatives of the lead applicant’s employing organization, the undersigned
hereby verify acceptance terms and conditions of the Alberta Innovates- Energy and
Environment Solutions call for proposals:
Team Leader’s Name
Title/Organization
Signature
Date
Authorized Representative’s Name
Title/Organization
Signature
Date
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