Cape Ann HeatSmart Alliance Energy Coach Consultation Request Form


The HeatSmart Alliance of Cape Ann offers free coaching (with trained community volunteers) for residents and building owners to learn about, plan for, and initiate actions such as adoption of home/building weatherization, efficient electric heat pump technologies, electric vehicles, solar, and/or other adaptations for our clean energy future.

Some of the many advantages of developing a clean energy plan for your home:

  • Individuals can substantially reduce their household carbon footprint 
  • Incentive programs exist for these energy upgrades; better incentives are anticipated in 2024.
  • Property values can increase with improved weatherization, on-site solar, and cold-climate electric heat pumps. Some energy improvements can provide a buffer against the price volatility of fossil fuels.
  •  Indoor air quality improves, reducing the negative health impacts of fossil fuel use, in particular on elders and children.

Please fill out this form to be contacted by an Energy Coach.

If you have questions, please reach out to the Cape Ann HeatSmart Alliance at HeatSmart Alliance - Cape Ann 

Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email *
Street Address 
[ at property in question ]
 *
City or Town
[ at property in question ]
 *
Phone *
How did you hear about the Cape Ann HeatSmart Alliance Energy Coaching program?*
 *
Required
What is the primary issue you are seeking help with?
 *
If you have a second issue you are seeking help with, indicate that here.
 *
If you have a third issue you are seeking help with, indicate that here.
 *
Are you planning any of the following?
How long are you planning on staying in your home? (years)
Clear selection
What are your priorities in terms of a conversion of your home's heating and/or cooling system? 
[ 1 for most important and 5 for least important ]
1st
2nd
3rd
4th
5th
Reducing my Carbon Footprint
Reducing Heating/Cooling Energy Costs
Reducing the Initial Cost of the Sysyem
Adding Cooling to the Home/Building
Minimizing the Aesthetic Impact of a Heat Pump Conversion
Other
At what point in the process are you of considering a heating/cooling system change? *
Home style
Year the home was built
Size of home (square feet)
[ If unknown, this may be on your tax assessment card ]
Primary heating fuel
Secondary heating fuel
What kind of AC/Cooling does your home have?
What is the current electrical service to your home / building?  
[ Can sometimes be seen inside panel box or written on a main circuit breaker ]
Clear selection
Mass Save Home Energy Assessment Status
Please read and agree to the following waiver before submitting this form:

As a participant in the Cape Ann HeatSmart Alliance  Coaching program, I have requested heating and cooling coaching services (the “Services”) from a volunteer coach who is a member of the HeatSmart Alliance.  In consideration of the receipt of the Services the undersigned agree(s):  
(i)    to assume responsibility for all purchasing decisions the undersigned may make regarding any heating or cooling system he/she/they may acquire and have installed in the Premises;
(ii)    neither the HeatSmart Alliance nor any of its volunteers, employees, agents, organizers, members, coaches, associates, nor any other  individuals or organizations assisting or participating in the coaching service (the “Releasees”) makes any representation or warranty, express or implied, regarding the Services, including without limitation any representation or warranty with respect to the operation or performance of any heating or cooling system
he/she/they choose to purchase and install in the Premises (“System”) and the performance and competence of any installer he/she/they may select to install any such System; and
(iii)    to release, hold harmless and not sue any of the Releasees from or on account of any claims and causes of action that may arise either directly or indirectly from the provision of the Services or the System, equipment or energy-saving measures he/she/they may purchase or the installation thereof, including without limitation any personal injury, building or property damage, shortfalls in energy or costs savings or comfort, defects or failures in the performance of the System and/or equipment or the negligence or inadequate performance of any installer.The undersigned explicitly acknowledge(s) that projections of energy, cost and carbon emission reductions and comfort improvements provided by the Releasees are based upon projections and assumptions that are subject to inherent uncertainty and may not be realized once any System or other energy-saving measures are installed.  
 *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms