THIS APPLICATION IS FOR RENTERS ONLY

If you own your home please complete the Energy Conservation for Homeowners application found at CHN offices

YOU MUST COMPLETE ALL PAGES IN THIS APPLICATION TO APPLY.

If there is more than (1) unit in your building, each tenant must complete an application. Your building may be ineligible if it has more than (4) units.

What services are you interested in applying for? (Check all that apply)

Weatherization Furnace, hot water tank, insulation, electrical box.

CEI/CPP Refrigerator and/or freezer replacement and light bulbs.

Is your Furnace Working? Yes No Is your Hot Water Tank working? Yes No Is your Refrigerator working? Yes No

I agree to allow CHN Housing Partners to place a marketing yard sign in my front lawn for a minimum of 3 weeks.

Upon approval, you will be added to our waitlist and an inspector will contact you to schedule an appointment once you are due for service.

*Signature_______________________________________________________

All Applicants Must Sign Here