Referral intake

Submit a household intake so ENS can assess the energy burden, eligibility fit, and likely next steps.

This form collects the household context, usage details, assistance history, and home concerns needed to begin an Energy Reduction Plan. After submission, a confirmation summary appears below.

First name Last name Email Phone Street address City County ZIP State

It is okay for the advisor to follow up using the contact information above.

Number of residents Building type Housing status Square footage Electric provider Heat provider Heating unit Referring agency Opt-in bonus

Annual electric use (kWh) Annual heat units Household income Electric rate ($/kWh) Heat rate ($/unit) State energy assistance status

If usage fields are left blank, ENS falls back to the workbook’s square-footage estimate logic so the intake can still be submitted.

Once submitted, this intake is saved for ENS. A short confirmation summary will appear below so you can confirm what was captured.

Submit a household intake so ENS can assess the energy burden, eligibility fit, and likely next steps.

Contact and household basics

Property and utility context

Consumption, rates, and income

Comfort, shell, and equipment concerns

Assistance, waitlists, and current programs

Submit this intake to ENS