* Required Field

Application for a Free Home Energy Assessment (Home Energy Score)

You may be eligible for an income-qualified free Home Energy Assessment.

To apply, please select the applicable qualifying program option and fill out the required fields. Be prepared to upload proof of program participation.

To qualify for this service, your household income must be at or below 60 percent of median family income for the Portland-Vancouver-Hillsboro, OR-WA Metropolitan Statistical Area.

Not sure? Verify your percentage of median household income.

If submitting outside of the automated form, all documentation may be submitted by:

Email - hesinfo@portlandoregon.gov with subject "City of Portland Home Energy Score Program Income-qualified Free Assessment Request"

Or hard copy - Attn: City of Portland Home Energy Score Program Income-qualified Free Assessment Request
Portland Bureau of Planning and Sustainability
1900 4th Ave. Room 7100
Portland, OR 97201

Check the box if you plan to list your home for sale in 2018. *

Choose the qualifying program option which applies to you.*

Upload proof of program participation*

(Maximum file size: 30MB)

If you do not participate in any of the programs listed above but are still income qualified, please complete the Attestation Form

Last Name*

First Name*

Telephone Number*

Additional Phone Number

E-mail Address*

Home Street Address*

e.g. 1120 SW 5TH or 5TH AND MAIN

Do you own the property?*

Do you own the property? YES NO

Demographic information (Optional)

We are gathering the following information to understand what populations are being served by this provision. Completing this portion of the form is optional.

Gender:

What is your age?

Do you identify as a person with a disability? If so, specify:

How do you identify yourself? (Check all that apply)

Hold Ctrl to select multiple items

If other, please specify:

Certification

I acknowledge and authorize BPS to send a Task Order to an on-call Home Energy Assessor for them to contact me to schedule a Home Energy Assessment at my residence. I have the responsibility as the owner to schedule the assessment and any additional steps necessary to allow this work to be performed by the Home Energy Assessor on my property. *

Electronic Signature

I certify that as the property owner I am voluntarily applying and consent to the submission of an electronic transaction to request an income qualified Home Energy Assessment through the City of Portland Home Energy Score program.*

Confidentiality

It is Bureau policy to provide confidential treatment for the voluntary submission of personally identifying information provided by you for this request. Your personally identifying information will be kept confidential unless you check the box certifying that you do NOT want confidentiality. Please note, the Home Energy Score and Report are not considered as personally identifying information.

I waive confidentiality.

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In the Pacific Northwest, what state is Portland in?

The City of Portland, Oregon

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Application for a Free Home Energy Assessment (Home Energy Score)