Menu Home Energy Counseling and Check-up Program In-Home Energy Check-Up and Counseling Energy Conservation Workshops Pop-up Energy Counseling Energy Resources Schedule an Appointment Schedule an Appointment Please complete the entire form below to request a Free Home Energy Check-up Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Family Size* Annual Household Income* Electric Account Number* Electric Utility Name*Delmarva PowerDelaware Electric CooperativeCity of DoverCity of NewarkNew Castle MSCTown of MiddletownTown of ClaytonTown of SmyrnaCity of MilfordLewes BPWCity of SeafordGas Utility Name- Please select one -Chesapeake UtilitiesDelmarva PowerPropaneNoneDo you receive any of the following (check all that apply):*Food StampsWIC (Women, Infants and Children)LIHEAP ( Low-Income Home Energy Assistance Program)TANF/GA (Temporary Assistance for Needy Families/General Assistance)MedicaidNoneWhat do you need help with? (check all that apply):*High utility billsTips for saving at homeBill payment assistanceUtility account issuesDisconnection/ReconnectionWeatherization / Home repairsHeating / Cooling problemsOtherHow did you hear about us?*Community EventFamily/FriendMailOnlineProgram flyerReferred by Electric UtilityReferral from another organizationWorkshopOtherWhich organization were you referred from? EmailThis field is for validation purposes and should be left unchanged. Δ
