Service Needs Request Forms - Hoʻāhu Energy Cooperative Molokai (HECM)

SERVICE NEEDS REQUEST FORM

Hoʻāhu Energy Cooperative Molokai (HECM)
Please fill out the form to its entirety, and press "Submit" at the bottom of the form upon completion. Your request will be reviewed within the order in which it is received.
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Client (Molokai Resident) Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Property Location Details
Property TMK*
Property Address*

Street Address

Street Address Line 2

City

Postal / Zip CodeCountry
Property Type & Status*
Questionnaire
How is your home currently energized?*
How would you prefer your home to be energized?*
Is your home on Homestead or Fee Simple?*
Are you the lessee or fee owner of the land in which your home resides?*
What best describes your home?*
Insert your home structure square footage here:*
Do you have any energy star appliances?*
Amount of Household members residing in your home?*
If yes, what appliances in your home are energy star (i.e. refrigerator)*
Anyone in your home uses medical equipment (i.e. oxygen machine, hospital bed)*
If yes, what medical equipment is used in the home that requires electricity: *
Do you reside on a compound (multiple living units on the same property) in which you are requesting service for these multiple living units?*
Service Needs
Provide a narrative on how you would like assistance with motioning your home toward clean renewable energy.*
Upload Property and Home Structure Image(s) Here:

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DISCLAIMER FOR SERVICE
The client accepts and agrees that she/he is 100% responsible for her/his progress and results toward accessing Hoʻāhu Energy Cooperative Molokai (HECM) services. HECM makes no representations or guarantees verbally or in writing to provide services to the client. HECM makes no guarantee or warranty that services will meet the client request and requirements or that all clients will achieve the same results.

HECM services are performed by students and volunteers under the supervision of qualified instructor(s). Instructors are encouraged to stimulate the educational opportunities and the clients need for service narratives is the driving force toward student educational opportunities. The services in which clients demand, the quality of the work performed, and the professionalism with which the students present themselves is what makes HECM graduates successful.
Mahalo!

Email workforce@hoahuenergy.coop if you have questions.
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SERVICE NEEDS REQUEST FORM