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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 SeafordDo 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 organizationWorkshopOtherNameThis field is for validation purposes and should be left unchanged.
