Weatherization Application

Cluster/Parish Name:

Contact Person:

Contact Phone:

Contact Email:

Geographic Area(s) Serviced:

Program Start Date:

Desired Number of Homes to be Weatherized:

Amount Requested ($):

What is the target population? Are services available to the entire community?:

Please describe the service(s) provided by the program and the materials that will be used (example: A flexible program to meet the needs of the household, window inserts, caulking, energy audits, etc.):

How long do you plan to spend on one home? How long do you think it will take to complete desired number of homes?:

Briefly describe the need for this service in your area. How do you feel your program responds to this need?:

Do you plan to collaborate with other organizations or groups?:

Project cost for materials:

Projected cost for labor:

Other costs:

Total costs:

How were these numbers calculated? (based on pervious experience, from research, estimations, etc.):

What is the maximum amount that will be spent on a home?:

Is there any initial funding? If so, how much?:

What are your fundraising plans?:

Submit