WAIT!  Have you already been approved for Energy Assistance through Energy Services, Inc.?  If not, please click here:  Energy Assistance Application before filling out this form.

Take the first step toward a more comfortable home!

Fill out this quick form so we can learn more about your situation. Our Weatherization Intake Specialist will be in touch soon to help you get started with next steps.

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This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Address(Required)

City(Required)

State(Required)

Zip Code(Required)

ZIP / Postal Code

Phone(Required)

Email(Required)

If you are a renter, please provide the building owner's information

Owner's Name

Owner's Address (with State & Zip)

Owner's Phone

Owner's Email

About Your Home

Type of home

Single Family Home

House Duplex

Apartment Building (4-24 units)

Condo

Type of Heating System

Furnace

Electric Baseboard

Boiler

Not sure

I am interested in (select all that apply)

Insulation

Air sealing

Refrigerator

Bathroom fans

Furnace work

Does your home have a roof leak?(Required)

No, not that I know of

Yes, minor roof leak(s)

Yes, roof needs to be replaced

**If you believe you need a roof replacement, our Major Home Repair programs may be able to help! Visit the Major Home Repair section of the site to find out more.

Does your home have any of the following? (select all that apply)

Ice damming

Mold/Moisture

Rodents/Bats/Pests

Damaged walls or ceilings

Is there any construction, or planned construction, at your home?

Yes

No

Is your home currently for sale or in foreclosure?

Yes

No

Do you have pets? (select all that apply)

Dog

Cat

Bird

Other

No pets

• Customer Bill of Rights
• Pet Policy

(Please read before continuing)

Please check each box below to confirm

As the owner or renter, I hereby certify:(Required)

I have reviewed a copy of the State of Wisconsin Division of Energy Services (Home Energy +) Customer Bill or Rights.

As the owner or renter, I hereby certify:(Required)

I have reviewed Project Home's Pet Policy, and agree to adhere to this policy.

As the owner or renter, I hereby certify:(Required)

I am aware that any materials potentially disturbed during the weatherization process may be tested for asbestos content.

As the owner or renter, I hereby certify:(Required)

I understand the property owner agrees not to increase the rent, solely because of weatherization improvements, for one (1) calendar year (beginning the date of a satisfactory final inspection).

(Condo Owners Only)

I agree to take all contracts with Project Home to my condo association for approval and have them co-signed by my condo association or other governing body at the property in which I reside.

CERTIFY ALL APPLICATION INFORMATION(Required)

By checking this box, I certify that all information on this application and given in connection with it is, to the best of my knowledge, a true and complete statement of facts.

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Listen to a short video on the weatherization measures you could receive through the Weatherization Assistance Program.