Area Based Grant Application Form

If you have already been contacted by your Local Authority, and would like to register for the programme, please complete the Grant Application Form below.

By submitting this form you are not commiting to the works. We will assess your application and confirm the level of grant that can be applied to your property. We will notify you in writing and our offer of grant will include details of the next steps should you wish to proceed.

1. Property details

If rented please provide landlord details in Section 5 below

2. Contact details

3. Previous Funding

Have you received any Scottish Government Grant Funding since 2nd October 2017?

4. 3rd Party Contact.

If you would like a friend or relative to represent you please provide their details

5. Landlord/Letting Agent/Housing Association

Only complete if you rent your home.

6. Additional Assistance Assessment

So we can assess your application to ensure you receive the maximum grant assistance available to you we would be grateful if you would answer the following questions.

Do you spend over 20% of your total household income, excluding disability benefits and childcare costs, on your fuel bills? (electric, gas, oil, coal etc.)
Is your Household in receipt of the Cold Weather Payment?

Is anyone in your household in receipt of any of the following benefits?

Please tick all that apply.

Pension Credit
Support for Mortgage Interest (SIM)
Income Support or Income Based Job Seekers Allowance AND have
  • a disability or pensioner premium
  • a child who is disabled
  • Child Tax Credit that includes a disability or severe disability element
  • a child under 5 living as part of the household
Income-related Employment and Support Allowance (ESA) AND
  • are in a work-related activity group or support group
  • a severe or enhanced disability premium
  • a pensioner premium
  • a child who is disabled
  • Child Tax Credit that includes a disability or severe disability element
  • a child under 5 living as part of the household
Universal Credit AND not employed or Self Employed AND have
  • a health condition or disability and have limited capability for work (with or without work-related activity)
  • a child under 5 living as part of the household
  • a child who is disabled (this applies whether employed or not)
Is someone in your household over 65?
Is someone in your household over 75?
Is this your main residence?
Have you live here for more than 12 Months?
Have you received another energy efficiency grant from the Scottish Government within the last 5 years?
Do you have a working heating system?
Is someone in the household pregnant or are there children under 16?

Is anyone in your household in receipt of any of the following benefits?

Please tick all that apply.

Personal independence payment
High Rate Disability Living Allowance DLA (care or mobility)
Low/Medium Rate DLA AND an income related benefit
Carer's Allowance
Armed Forces Independence Payment/ War Disablement Pension
Industrial Injuries Disability Benefit
Guaranteed Pension Credit
Attendance Allowance
Council Tax Reduction (not single persons 25% discount) fit).
Universal Credit (previously income related JSA, Child tax credit, Working Tax credit, ESA, income support or housing benefit)

7. Data Protection Consent

The Energy Agency is the data controller responsible for collecting and processing your personal information.

In relation to the Energy Efficiency Scotland: Area Based Schemes (ABS), the enclosed Privacy Notice specifies the nature of your personal information that we will hold and process, the purposes for doing so, the third parties with whom we may share this with and what we intend to do with your information. It also confirms for how long we will hold your personal information, and sets out your rights in relation to it.

You have the right to withdraw your consent at any time. This can be done verbally or in writing to the Energy Agency. We do not share your information with any third parties for marketing purposes. We regularly review the systems, policies and procedures we have in place to protect your information and ensure these are implemented.

Please refer to our Privacy Notice for full details.

By signing the declaration below you are confirming your agreement to these points.

There may be future energy saving schemes that will benefit you, please tick the box if you would like to be contacted about these.

8. Declaration

I consent to the Energy Agency holding my personal data and confirm that any information I have provided to the Energy Agency is current and accurate.