Assessment Recommended Improvements Incentive Form

ELIGIBILITY CRITERIA

 Home being improved must be on cooperative’s lines. Incentive not to exceed the cost of energy efficiency improvements, up to $500. Cost can include material and professional labor. The cost of the Assessment cannot be included. Energy efficiency improvements must be recommendations from an assessment arranged by your cooperative or a cooperative‐approved partner. The Assessment must be a comprehensive Assessment, including a written report. The Assessment report must indicate the improvement will result in electrical or delivered fossil fuels (LP, oil) reduction or efficiency. If another incentive is available, the Assessment recommended improvement will qualify for only that incentive. For example, if an assessor recommends purchasing an ENERGY STAR refrigerator, the refrigerator will qualify for the Appliance incentive, not the Assessment Recommended Improvements incentive. Improvements must be completed within 24 months of the Assessment date. Each member account qualifies for only 1 Assessment Recommended Improvement incentive every 5 years, regardless of the number of Assessments performed and regardless of the number of measures implemented. Incentives are in place through December 31, 2021. Funds are limited so submit required documentation as soon as possible. Required documentation must be submitted within 3 months of implementation of Assessment Recommended Improvements. If submitted after December 31, 2021, improvements will be considered for the 2022 incentive if offered. Additional eligibility criteria may apply. Program is subject to change or cancellation without notice. Contact cooperative for details.

MEMBER INFORMATION

First Name

Last Name

Contact Information

Email Address

Main Phone Number

How do you prefer to be contacted?

ASSESSMENT INFORMATION

Date of Assessment

Water Heater Fuel Type:

Electric

LP

Other…

Home Heating Fuel Type:

Electric

LP

Fuel Oil

Other…

Upload Assessment Documentation - Document File

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Energy Efficiency Improvements & Cost (one line per Improvement):

Total Cost of Improvements

(Sum of lines above)

$

Total Incentive Amount Requested

(Enter the amount entered in previous box or $500, whichever is less)

$

Upload a copy of your receipt or invoice for each improvement with purchase price(s) circled - Document File

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Upload a copy of your receipt or invoice for each improvement with purchase price(s) circled - Image File

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Assessment Recommended Improvements Incentive Form