GWP In-Home Display & Thermostat Program Questionnaire

Print

Thank you for your interest in the GWP In-Home Display and Thermostat Pilot Program. As part of this Pilot Program you will receive a free smart thermostat and a CEIVA Homeview Display to help you keep track of your energy and water usage.

Eligibility Customer Questionnaire For The GWP In-Home Display and Thermostat

This questionnaire is to determine your eligibility in this program in order for us to test multiple scenarios to make sure your home fits the criteria. The following types of homes WILL NOT QUALIFY for this pilot program (if any of the criteria below applies to you, do not proceed with this questionnaire as you will not be selected to participate):

  • Multi-family homes
  • Homes without central air conditioning
  • Homes with photovoltaic systems/solar panels.

Please be patient as eligibility assessment and customer contact will take several weeks. If you have any questions about the program, please email us at GWPconservation@glendaleca.gov.

Please correct the field(s) marked in red below:

1
Name
 *
2
Address
 *
3
Phone Number
 *
4
Email address
 *
5
GWP Account Number (Please look on your GWP bill)
 *
6
Do you live in a single family home?
 *
Do you live in a single family home?
7
Do you live in a condo or duplex?
 *
Do you live in a condo or duplex?
8
If yes, approximately how many feet away is your home from your electric meter?
9
Does your home have a central air conditioner?
 *
Does your home have a central air conditioner?
10
Do you plan to move out in the next 12 months?
 *
Do you plan to move out in the next 12 months?
11
Do you have an internet connection at home?
 *
Do you have an internet connection at home?
12
If you are a renter, you will need to fill in a rental/landlord permission form that we will e-mail to you. 
 *
If you are a renter, you will need to fill in a rental/landlord permission form that we will e-mail to you.
13
Do you have solar panels in your home?
 *
Do you have solar panels in your home?
14
Do you own an electric vehicle?
 *
Do you own an electric vehicle?
Click here to view the In-Home Display and Thermostat Program Agreement
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code
     

    Free viewers are required for some of the attached documents.
    They can be downloaded by clicking on the icons below.

    Acrobat Reader Flash Player QuickTime Windows Media Player Microsoft Silverlight Word Viewer Excel Viewer PowerPoint Viewer