Emergency Backup Microgrid Interconnection Form
Applicant Information
Organization Name
Contact Name
Email
Phone
Address
Facility Information
Facility Name
Facility Type
Facility Address
City
State
Zip Code
Microgrid Details
Total Capacity (kW)
Microgrid Type
Solar
Battery
Wind
Diesel Generator
Other
If Other, specify
Is the microgrid intended for emergency backup only?
Yes
No
Estimated Date of Interconnection
Technical Contact
Name
Email
Phone
Additional Information
Comments or Special Requirements