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									                                                                                           Rural Electric Program
EGTS Number                        REA/Utility
                                   Reference Number
                                                                       Rural Electrification Grant Application

                                                                                          For Department Use Only
Applicant Information:                        Land Description:
REA Name:                                     M      RG TWP         SEC QTR A. Basic Cost
Contractor:                                                                     Basic Cost of Service:
Last Name:                                    Lot         Block                 less Threshold ($4,500) =

                                                                                x 0.50

First Name:                                   Plan                             GRANT: (max $5,250)

Address:                                                                        or

City/Town:                                    Service Details:                  B. Basic Cost:

Province:                                     Service Length:                   Basic Cost of Service:

Postal Code:                                  Capacity:                         less Company Investment

Res. Phone:                                   Service Type:                    GRANT:

Work Phone:                                   Service Phase:

Fax:                                          Construction:
                                                                                GRANT = Lesser of A or B
Cell:
E-mail:                                       Irrigation Service:    Yes        Project Costs Reviewed:
                                                                     No
                                                                                Rural Utilities Division
Alberta Farm Fuel Benefit Number:                                              Fiscal Year ___________________

                                                                               65% Allocation
Signature of Applicant:                                   Date:

Signature for REA:                     Date:
TO BE COMPLETED BY THE REA / POWER COMPANY ONLY

Application form completed by:                                                       Phone:
Service Point or District:                                                               Fax:
                  Detailed cost breakdown, detailed sketch and area map required with application.
       SERVICE COMPLETED            No _________          Yes _________        Completion Date ______________________

          PLEASE NOTE: GRANT MUST BE ADVANCED WITHIN ONE YEAR OF SERVICE BEING COMPLETED

 The information that may identify you on this form is being collected for the purpose of determining eligibility for a Rural
 Electrification Grant under the authority of the Government Organization Act. It is subject to the provision of the
 Freedom of Information and Protection of Privacy Act and is kept only for the length of time necessary to fulfill the
 purpose for which is was collected. If you have any questions about the collection, contact Rural Utilities Division toll
 free at 310-0000 then (780)427-0125.


       Rural Utilities Division- Room 202, J.G.O'Donoghue Bldg., 7000 - 113 Street, Edmonton, AB, T6H 5T6
       Phone: (780) 427-0125 Fax: (780)422-1613
       www.agric.gov.ab.ca/Programs and Services/Rural Utilities                     Last updated: February 16, 2011
Rural Utilities Division- Room 202, J.G.O'Donoghue Bldg., 7000 - 113 Street, Edmonton, AB, T6H 5T6
Phone: (780) 427-0125 Fax: (780)422-1613
www.agric.gov.ab.ca/Programs and Services/Rural Utilities                     Last updated: February 16, 2011
                           Farm         Single    Overhead

                           Irrigation   3 Phase   Underground




Rural Utilities Division- Room 202, J.G.O'Donoghue Bldg., 7000 - 113 Street, Edmonton, AB, T6H 5T6
Phone: (780) 427-0125 Fax: (780)422-1613
www.agric.gov.ab.ca/Programs and Services/Rural Utilities                     Last updated: February 16, 2011

								
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