Decarb Somerset Information Capture

1
Organisation Name* This field is required.What is the name of the organisation that you are representing
2
Organisation address* This field is required.
Street Address
Street Address Line 2
City
Post Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Organisation Email* This field is required.For internal use only
example@example.com
4
Organisation phone number
5
Please provide your organisation's website addressIf you have a website please provide the website addess
6
Do you have a Facebook profile?
YESNO
7
If yes, please provide the Facebook addressExample: https://www.facebook.com/Ruralsomerset
8
Your name, who is completing this sign in form?* This field is required.This is for administration purposes
First Name
Last Name
9
Please can you provide your email address* This field is required.
example@example.com
10
Please can you provide your telephone number
11
This next section is about the building that you own, rent or have permission to adjust / make renovations to.
12
Do you own or rent your building? * This field is required.
OWNRENT
13
Can you make change in your building?* This field is required.This could be as simple as changing a light bulb, separate recycling bins, reducing the use of packaging or through to larger structural changes such as changing heating systems, installing solar panel etc.
YESNO
14
Which sector best describes your organisation?* This field is required.Please select one of the below options
Offices (soial enterprises and charities)
Community businesses (pubs, shops)
Community venue (libraries, community buildings, scout huts, church rooms, sports club etc)
Other
15
What is your legal structure?* This field is required.
Unincorporated Association
CIO (Charitable Incorporated Organisation)
CIC (Community Interest Company)
Charitable Trust
Community Benefit Society
Cooperative Society
Company Limited by Guarantee
Other
16
What is the building's annual energy usage (specify 12 month period)?* This field is required.Please provide this as kiloWatt hour/year
17
What is the building's annual energy spend (specify 12 month period)?* This field is required.If you are unsure of how to get this information here is a free calculator to enter your kiloWatt hours against your hourly charge rate from your energy supplier: https://energyguide.org.uk/electricity-cost-calculator/
18
What type of energy does your building currently use* This field is required.
Oil
Electricity
Gas
LPG
Solar
Heat pump
Wood
Other
19
Have you completed any of the below:* This field is required.
DIY Energy Audit
Paid for/commercial energy audit
Decarbonisation Plan
Carbon Footprint calculation
Environmental Policy
None of the above
Other
20
What do you want from this project?* This field is required.
Funded energy audit
Better understanding of my building's energy usage
Reduce my energy spend
Quick wins
Improved biodiversity
121 Support
Recommended suppliers
Greener/cleaner energy solutions
Renewables focus
Peer to peer support
Fundraising advice
Other
21
Have you received any sustainability, net zero or energy support in the last 2 years?* This field is required.
YESNO
22
If yes who was the provider?* This field is required.
23
Privacy Statement

CCS may use personal data for the purposes of managing the charity, its memberships, consultations, finances, running and marketing events, staff employment, and fundraising activities. Data may be retained for legitimate purposes to comply with legislative and contractual purposes. If you would like to find out more about how we use /hold your data, please contact info@somersetrcc.org.uk or call 01823 331222. Protecting your Personal Data is important and we fully adhere to the Principles of Data Protection set out in our Data Protection / Privacy Policy visit: https://ccslovesomerset.org/ccs-policies/

This project is funded by the UK government through the UK Shared Prosperity Fund
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