The following form is meant to serve as a template and is provided for informational purposes only. Please adapt to fit your project’s needs.
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Only one representative from each prospective block should submit a response to this Opportunity
Notice. For questions, please email [insert email here]
Full name of block representative:
Address (Street, zip code):
Email:
Phone:
Preferred method and time(s) to reach you:
Block bordered by which streets:
Number of neighboring homeowners on the block who are interested:
Street addresses (if possible):
Please attach map with interested houses marked (if possible).
Estimated average annual energy bill (gas and electric) across all interested housing units:
Please provide a few sentences describing why your block should be considered:
Please describe ways that you and/or your neighbors participate in activities in your neighborhood or
other community activities currently:
Please submit online at [insert URL] or by mail to [insert address] by [insert deadline].