Extension Services Initial Intake Form

Please use this form to request Energy Extension Services. If you have questions, please contact the Extension Program Contact provided in the left sidebar.

AT THIS TIME, SERVICES ARE ONLY AVAILABLE TO APPALACHIAN FACULTY, STAFF AND STUDENTS.

Section One: Your Information

First Name *

Last Name *

Phone Number *

Email Address *

How did you hear about this program?

Section Two: Property Information

Property Type *

Physical Address of Property *

Which best describes your connection with the property? *

Which sources of energy are used in this building? Check all that apply. *

Utility Name(s):

Other Energy Source:

Section Three: Assistance Sought

Please select the services you are interested in: *

The Energy Efficiency Assessment includes a visual diagnosis of energy efficiency improvements that could be made to the structure and how it is used. It might also include air leakage test of the structure. A Renewable Energy Assessment will help you learn whether generating clean energy is viable on your site and, if so, how it might effect your energy costs. We recommend an Energy Efficiency Assessment be completed at the same time. At this time, we can assess the potential for 1) Solar Photovoltaic (PV) to generate electricity and 2) Solar Thermal to provide heat, most often to heat water.

Section Four: Additional Information

To connect people with the best resources, it is helpful to know what steps, if any, you have already taken to reduce energy consumption in this building and/or to generate renewable energy. Please describe efforts you (or a previous owner) have made. Examples include air sealing, updating HVAC or lighting, replacing windows or doors, gathering quotes for any of this work or insulation improvements.

Please provide any additional information you think is relevant to this request.

This question is optional. If you prefer not to share or need help estimating this, please leave this question blank. This information helps us understand your energy burden (the percentage of income spent on energy) so that we can recommend programs that have eligibility guidelines.

Please estimate one or both of the following:

Percentage of your gross monthly income spent on energy in an average month
Total monthly energy cost as percentage of monthly rent:

Example: A tenant paying $500 per month in rent pays $75 per month in electricity and $300 per year in heating fuel.
1. $300 divided by 12 months equals $25 per month in heating fuel
2. Plus $75 per month in electricity, equals $100 total energy costs per month
3. $100 divided by $500 equals 0.2 or 20% of monthly rent expenses spent on energy costs

Estimate(s):

Section Five: Eligibility Confirmation

At this time, Energy Extension Services are only available to current faculty, staff and students at Appalachian State University. Please type your name below as it would appear in University records to confirm your eligibility.

Full Name *

Leave this field blank

Appalachian Energy Center

Extension Services Initial Intake Form