Free and Reduced-Cost Energy Upgrade Services
Submitted by Who
Staff
Unknown
Other
Initial Contact Channel
Application Source
Referral Partner Id
Check all that interest you
Yes, I want FREE Quick Energy-Saving Installs
Yes, I want my whole home inspected for energy efficiency upgrades
Yes, I want solar panels on my roof
Yes, I want to subscribe to a community solar project through Neighborhood Sun
I don't know! I'd like to start by learning more from a Civic Works Energy Advisor
Name of person submitting the form
Contact Information
First Name
Last Name
Mobile Number
Home Number
Email
Address
Street Address
Street Address Line 2
Add your apartment number here
City
State
Postal / Zipcode
Income
We offer grants to weatherize homes based on whether your income is above or below 80% of the AMI limit shown below. Are you above or below?
Above
Below
Household Size
Annual Household Income
(80% AMI)
1
$72,950
2
$83,400
3
$93,800
4
$104,200
5
$112,550
6
$120,900
7
$129,250
8
$137,550
Are you or anyone in your household age 65 or older?
Yes
No
Help us spread the word
List any friends or family you recommend who can benefit from our services, their name and phone number:
List any community centers, community associations, places of worship, or workplaces that you recommend for a presentation by Civic Works Energy Programs?
How did you hear about us?
Any final comments or questions for a Civic Works Energy Advisor?
For Staff
Staff Name
Event Name
Tentative Site Visit Date
Tentative Site Visit Time of Day
ex: 1pm, morning, or 3-5pm
Any additional comments for Energy Advisors to be aware of?
Contact Information