1. EXISTING HOME CONDITIONS AND MECHANICAL EQUIPMENT MUST MEET PROGRAM SPECIFICATION REQUIREMENTS TO BE ELIGIBLE FOR ENERGY EFFICIENCY UPGRADES.
2. ALL DWELLINGS AND SPACES INSIDE THE DWELLING MUST BE ACCESSIBLE AND PROVIDE SAFE WORKING CONDITIONS FOR THE INSTALLATION CONTRACTORS. 3.
ENERGY OUTREACH COLORADO’S ACCEPTANCE OF A SUBMITTED APPLICATION DOES NOT GUARANTEE THAT THE CUSTOMER OR MEMBER’S HOME WILL RECEIVE ENERGY
EFFICIENCY UPGRADES TO THE HOME. 4. ENERGY OUTREACH COLORADO AND ALL OF THE CARE PROGRAM UTILITIES RESERVE THE RIGHT TO CONDUCT AN ON-SITE
INSPECTION OF THE FUNDED ENERGY EFFICIENCY MEASURES. THE CUSTOMER OR MEMBER AGREES TO PROVIDE REASONABLE ACCESS TO INSPECT THE INSTALLATION.
ON-SITE INSPECTIONS MAY BE PERFORMED UP TO ONE YEAR AFTER THE INSTALLATION DATE OF THE ENERGY EFFICIENCY MEASURES. 5. ENERGY OUTREACH COLORADO
AND ALL OF THE CARE PROGRAM UTILITIES ARE NOT RESPONSIBLE FOR THE PROPER DISPOSAL/RECYCLING OF ANY WASTE GENERATED AS A RESULT OF THIS PROJECT;
ARE NOT LIABLE FOR ANY DAMAGE CAUSED BY THE OPERATION OR MALFUNCTION OF THE INSTALLED EQUIPMENT; AND DOES NOT GUARANTEE THAT A SPECIFIC
LEVEL OF ENERGY OR COST SAVINGS WILL RESULT FROM THE IMPLEMENTATION OF ENERGY EFFICIENCY MEASURES OR THE USE OF PRODUCTS FUNDED UNDER THESE
PROGRAMS. 6. APPLICANTS WILL NOT BE ALLOWED TO SKIP ELIGIBLE ENERGY EFFICIENCY MEASURES THAT ARE DEEMED TO BE COST EFFECTIVE. INSULATION, AIR
SEALING, AND LOW COST MEASURES MUST BE ADDRESSED BEFORE THE REPLACEMENT OF MECHANICAL EQUIPMENT CAN BE CONSIDERED.
Aid to the Blind (AB)
Aid to the Needy Disabled (AND)
Supplemental Nutrition Assistance Program (SNAP)
Old Age Pension (OAP)
Temporary Aid to Needy Families (TANF)
Social Security Income (SSI)
Social Security Disability Income (SSDI)
Supplemental Security Income (SSI)
Women, Infants, and Children (WIC)
Section 8 Housing
You will AUTOMATICALLY qualify for the CARE program if you are currently recieving or enrolled in any of these benefits:
LEAP (Utility Bill Assistance)**
Applicants may submit their completed and signed applications to EOC or your local CARE organization.
Energy Outreach Colorado
Attn: CARE Program
225 E. 16th Avenue, Suite 200
Denver, Colorado 80203
Signature of Applicant Date
I certify that the information given on this application and in any other supporting documentation is accurate and true. I release my utility provider and
Energy Outreach Colorado of any and all liability for supplying or requesting such information. I release EOC to provide information for additional services.
Additionally, if work is approved to proceed, I will assure that an adult will be present during any scheduled work inside my home.
Proof of benefit from above list Most recent income (3 most recent paystubs)
Most recent Tax Return-IRS Form 1040*
Wages or Tax Statement W-2*
Retirement Benefits Letter
Letter from Employer
Annual Household Income Pre-Tax (entire household income must be represented): $ _______________________________________________________
Required Income Verification Documentation
Applicant MUST submit one of the paperwork options below with the completed application.
* Please remove Social Security Number from documents
** If you are currently receiving LEAP benefits, or enrolled in the current program year, no Income Verification Documentation is needed.
Electric Utility Provider ________________________________________________ Account # ___________________________________________________
Natural Gas or Propane Utility Provider __________________________________ Account # ___________________________________________________
CURRENT ENERGY PROVIDERS
You can find this information on your utility bill. This information MUST be provided and accurate in order to process the application and receive services.
Utility Account Holder’s Full Name ______________________________________ Relation to Applicant _________________________________________
OFFICE USE ONLY
Household Income: ____________________ Referral Program: ____________________
Houshold Assistance and Income Verification Documentation not requred if income is pre-approved through a referral program.