APPLICATION FORM

for a subsidized institutional solar water heating system to be installed within the framework of the project
"SOLAR ENERGY ZIMBABWE"

NAME OF INSTITUTION:

PHYSICAL ADDRESS:

TEL/FAX:

E-MAIL:

NAME AND DESIGNATION
OF PERSON IN CHARGE:
   
1.

Choose the category of your institution
 

2.

Have you got water heating at your hospital / school / home etc?
 

  YES            NO

3.

What do you use for water heating at the current moment?
 

COAL    FIREWOOD    ELECTRICITY    SOLAR    N/A
4.

How reliable is your electricity supply from ZESA?
 

100%    80%    50%    25%    10%    >0%    N/A
5.

Have you got a reliable electrical back-up supply?
 

YES            NO
6.

What is your main consumer of hot water?
 

KITCHEN / DISHWASHER    LAUNDRY    SHOWERS / BATH
7.

Solar water heating would be needed to
 

GET HOT WATER ON THE SITE
REDUCE CONSUMPTION OF ELECTRICITY
REDUCE CONSUMPTION OF COAL/FIREWOOD

IMPROVE HYGIENE
RAISE COMFORT
DON'T NEED
8.

Is your cold water supply sufficient throughout the whole year?
 

YES    NO     DON'T KNOW
9.

Is your cold water supply stretched to the limit?
 

YES    NO    DON'T KNOW
10.

Where do you get your cold water from?
 

BOREHOLE
DAM
RIVER

MUNICIPALITY                         DON'T KNOW
ZINWA
RURAL COUNCIL
11. Number of beds in your institution?
 

5 - 10
11 - 20
21 - 50

51 - 100
101 - 200
201 - 300

301 - 400
401 - 500
MORE

DON'T KNOW
12.

Who is (are) the owner(s) of your institution?
 

CENTRAL GOVERNMENT
LOCAL GOVERNMENT
PRIVATE

CHURCH ORGANISATION          DON'T KNOW
TRUST
OTHER
13.

Funding for your institution comes from
 

CENTRAL GOVERNMENT
LOCAL GOVERNMENT
PARENTS
MEDICAL AID

FEES
CHURCH ORGANISATION
TRUST
PRIVATE DONORS

FOREIGN AID
OTHER
DON'T KNOW
14.

Please allocate points to the listed expenditures according to their respective weights in your annual budget (10 points for the biggest, 9 points for the second biggest spender, ..., and 1 for the lowest)
 

SALARIES
SCHOOL FEES
KITCHEN / FOOD
ELECTRICITY
FIREWOOD / COAL
WATER

LAUNDRY
GENERAL MAINTENANCE
NEW BUILDINGS
CLINIC / MEDICINE
SECURITY
CLOTHING / LINEN
15.

Do you have a maintenance workshop on your premises?
 

YES            NO            DON'T KNOW
16.

Your maintenance staff is
 

QUALIFIED AND EXPERIENCED    UNQUALIFIED BUT EXPERIENCED    NONE