Homeowner Clean Energy and Housing Consultation Intake Form

Homeowner Clean Energy and Housing Consultation Intake Form

Thank you for your interest in My Path to Safe Housing Initiative and our Clean Energy Decision Support services. Please complete this short form to help us prioritize your consultation and eligibility for potential grants, rebates, and services. Completing this form does not guarantee funding but ensures you are considered for available programs and services.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Do you currently own your home?*

YesNo
What type of home do you live in?*
Approximate year your home was built*
Are you interested in clean energy solutions?*

YesNoMaybe
Please describe any current energy or housing concerns you have*
Should be Empty: