Energy Design Assistance
Admin Sign In
PRINT

Energy Design Assistance Application

  • Enter as much information that is known at this time; the rest can be entered later.
  • Fields marked with a red bar are required.
  • After entering information, click the “Submit” button at the bottom of the page to save your progress.
  • Once the information is submitted, you will receive a link via email that can be used to access the form again, or forwarded to others to complete more of the application.
Application
Energy Design Assistance
  • Created 2/25/2021 12:55:14 PM
Your Information
First Name:
Last Name:
Company Name:
E-mail:
Phone:
Project
Project Name:
Street Address:
City:
State:
ZIP:
BUSINESS CUSTOMER INFORMATION

Please ensure all contact information is correct, as all rebate checks will be sent to this address.

Company Name:
Billing Address:
City:
State:
ZIP:

Customer Contact

Name:
Phone:
E-mail:

Alternate Recipient

Name:
Address:
City:
State:
ZIP:
Phone:
E-mail:

Customer Utility Account Manager

CUSTOMER'S DESIGN TEAM INFORMATION

Please fill out the name, contact, phone and e-mail address for each of the following:

Architectural Firm

Name:
Contact:
Phone:
E-mail:

General Contractor

Name:
Contact:
Phone:
E-mail:

Mechanical Engineer

Name:
Contact:
Phone:
E-mail:

Electrical Engineer

Name:
Contact:
Phone:
E-mail:

Development Company

Name:
Contact:
Phone:
E-mail:

Other Design Team

Name:
Contact:
Phone:
E-mail:
CERTIFICATION INFORMATION
Are you planning on obtaining a green building certification (3rd party verification)?
ENERGY DESIGN ASSISTANCE APPLICATION: SCREENING FORM

Schematic Design

Start Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
End Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Notes on Schedule:

Design Development

Start Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
End Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Notes on Schedule:

Architectural Construction Documents

Start Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
End Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Notes on Schedule:

M/E Construction Documents

Start Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
End Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Notes on Schedule:

Construction Schedule

Start Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
End Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Notes on Schedule:

Design Process


Building Information

Does this square footage include multi-tenant/lease type spaces?

Heating and Cooling






DESIGN CONSIDERATIONS OPTIONS

Willingness to Consider Energy Saving Alternatives

HVAC system alternatives:
If yes, describe the alternative systems:
Orientation-building layout
Wall/roof insulation:
Glazing type-window design:
Lighting design/controls:
HVAC efficiency/controls:
Demand response strategies:
On-site renewables:
Electric vehicle charging stations:
Energy efficiency financing opportunities:
Special considerations and other comments:


How did you hear about the Energy Design Assistance program?
select

Authorization
Terms & Conditions   

The customer agrees that sponsoring utilities* may make agreements with Customers by electronic means, that such agreements have the same legal effects as agreements entered into on paper and that such electronic agreements are authentic and valid. Customer also agrees to receive Energy Design Assistance Program information in electronic form (e.g., by email). Please note that this information must be signed by both parties in order to be valid and approved.

Customer Authorized Signatory: Authorized signer (please type full name)

Date:
Design Team Authorized Signatory: Authorized signer (please type full name)
Date:
Note: Clicking the 'Submit' button will notify program administrators for further action, but does not finalize this application.
Upon submission you will receive an email confirmation that will include a link to allow you to make further modifications.

View all programs

Willdan partners with utilities to bring Energy Design Assistance programs to customers nationwide

©2021 Willdan | version 6.1.0.5452
Twitter LinkedIn