Application for Weatherization Waiting List

The weatherization program works throughout Clackamas County, helping residents to reduce their heating and cooling costs, and make their homes safer and more comfortable. The program provides free weatherization and energy education to low-income renters and homeowners that qualify.

Name
Address
Mailing Address (if different)

Household Members

Ethnicity (select any that apply)
Race (select any that apply)

Household Information

Type of Housing
Type of mobile home:

Home Energy Information

Are you receiving Energy Assistance/Utility Support?
Heating Type Account must be in applicant's name
OTHER Combustion Appliances (Mark if applicable)
Type of Heating System:

General Information

Was home previously Weatherized?
Do you own your home or are you buying it?
Are you renting your home?

If so, please provide landlord information:

Do you live in public housing?
Does your home have a basement?
Does your home have a crawlspace?
Does your roof leak or is there physical damage to the inside from roof leak?
Does your home have plumbing issues?
Are you currently remodeling or doing construction on any part of your home?
Does your home have electrical Issues?
Have you noticed moisture damage or mold/mildew growing?
Is your home listed for sale OR do you have plans to sell?
Are you interested in an Energy Education Workshop?
Have you taken an Energy Education Workshop in the past?
Are you interested in a home visit with our Energy Educator?
I authorize the sharing of information to other non-profit or service organization for the purpose of referral to resources for which I may be eligible.
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