Community Mobilization Intake Form
Boston Workers Alliance Home Weatherization Program:

If you're a Boston resident and live in a home or building with 1-4 units, sign up today to receive a follow up info call to learn about getting a free home energy audit and weatherization. If you are between 60-120% of average income, you can receive up to $3,500 of free work done on your house. If you are below 60% of median income, you can get up to $6,500 of free work done. Weatherization can save you up to 30% on your home heating bills and will make your house more comfortable!

Join the movement to save the environment while cutting your heating costs today!  

Contact green@bostonworkersalliance.org or call 617 606 3580 to reach the BWA today.  

www.BostonWorkersAlliance.org

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First Name *
Last Name *
Street *
City *
Zip/Postal Code *
Phone *
Day Time Phone #
E-mail Address
Preferred Language
If other, what language do you speak?
Heating Fuel (Primary) *
Owns or rents? *
Landlord Name
Landlord Phone Number
Electric Utility
Clear selection
Gas Utility
If primary heating fuel is natural gas
Clear selection
Oil/Propane Provider
Sent to NSL
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