Application Form


Family members under the age of 18.
Include earnings from payroll, dividends, PFDs, etc. Do not use any periods, commas or dollar signs.
Assets can include dividends, retirement account, pensions, deferred compensation accounts, trusts, etc. Do not use any periods, commas or dollar signs.
List all home heat sources (oil boiler, oil stove, propane, baseboard electric, wood, pellet, other)
Provide an approximate total square footage of your heated living spaces.
A room is a space that you currently use and that is heated on a regular basis.
Selected Value: 0
Try to estimate the efficiency of your home: tight, leaky, well or poorly insulated, single pane windows, double pane windows, drafty, well insulated, etc.