Due to potential high customer participation and program oversubscription, we reserve the right to restrict services to homes that could benefit the most. This program is subject to change based on available funding. Currently, until Dec. 31, 2020 the co-pay is $0. Filling out this form does not automatically qualify you for the HES program. if your home is selected, you will be notified via letter or telephone. An authorized adult must be present during the assessment and provide access to the premises. Click here for printable copy.

Contact Information

Fields marked (*) are required. Please use name and address as printed on utility bill.






Utility Accounts
*Electric Acct #
 EVERSOURCE UI Other
*Natural Gas Acct # (if using gas)
 CNG SCG EVERSOURCE Other None
About My Home

 Apartment Single Family Condo Duplex

I live in my house:  Year-round Part of the year

Age of home:   *Heated Square Footage of Home:

Do You

 Rent** Own
** If you rent please print and fill out a hardcopy of application and have your landlord sign it
[click here for printable copy]

*Primary Source of Heat

 Electric Forced Hot Air Hot Water Baseboard Other

Do you have an oil, propane or kerosene heating service contract?  Yes No

Primary Heating Fuel Type

 Electric Gas Oil Propane Other

Primary Hot Water Type

 Electric Gas Oil Propane other

Central Air Conditioning

 Yes No   Age of Central A/C (in years):

Household Income

To determine if you are eligible for additional services, please check the appropriate box:

Gross Household Income
 $0–$39,000 $39,000–$51,000 $51,000–$63,000 $63,000+

How many individuals live in your home?

How did you hear about the HES Program?

 Bill Insert Direct Mail Radio TV Other

Have you participated in any in-home utility conservation programs within the past 18 months?
 Yes No
If yes, please describe:

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