Thank you for your interest in the In-Home Energy Services offers! The following questionnaire is to determine eligibility for a free home energy assessment and low to no-cost energy efficiency upgrades. Please answer as many questions as possible, and you will be notified regarding the offers available. If completed by a third party, please include the organization name, primary point of contact, and phone and/or email address. The In-Home Energy Services Program is managed and delivered for Energy Trust of Oregon by CLEAResult Consulting Inc.
You must provide either mobile OR home phone number.
Required if participant is a renter. Renters must contact their property owner/manager prior to participating. Upon completion of this intake form, a participation agreement will be provided to the property owner/manager and must be signed before an assessment may be completed.
"Income" includes any income or funds you receive or that is received by people you count as living in your household.
You must provide either annual OR monthly income information.
By submitting this form, I acknowledge and agree to these Terms and Conditions and understand that the information I provide, including personal information, may be collected, used, and shared by Energy Trust of Oregon, CLEAResult, and their program partners as described in the Terms and Conditions, for program purposes, including determining eligibility and delivering In-Home Energy Services. I understand that submitting this form does not guarantee eligibility, services, or incentives, and that a signed Form 350IES and in-home assessment are required before services begin.IES is a voluntary program. Participation depends on multiple factors including being a customer of an Energy Trust participating utility, incentive eligibility, and timely responsiveness. Additionally, customers can be removed from participation for unsafe or inappropriate conditions or behavior at the sole discretion of Energy Trust.If form is being submitted by another party on Customer's behalf, I acknowledge that I read this statement and the Terms and Conditions to the customer and received permission to submit form on their behalf.