Low-Income Energy Accessibility Project Survey
Personal Information
Full Name
Email Address
Phone Number
Home Address
Household Details
How many people live in your household?
Type of housing
Apartment
Single-family home
Mobile home
Other
Energy Usage
What is your household's main energy source for heating?
Electricity
Natural Gas
Propane
Wood
Other
Average monthly energy bill ($)
Accessibility
Have you ever had difficulty paying your energy bill?
Yes
No
Do you have access to any energy assistance programs?
Yes
No
Comments
Please share any additional comments or concerns regarding your household energy accessibility.