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Green CNY Intake Form
Thank you for your interest in Green CNY. Please fill out the Intake Form below to be contacted by our Community Energy Advisor
Name
*
First Name
Last Name
Address
*
Phone Number
*
Email Address
*
How Many People in Your Household
Annual Gross Income
Do you rent or own your home?
Rent
Own
Did you receive HEAP or SNAP benefits last year?
Yes
No
What types of assistance are you looking for from GREEN CNY?
Thank you!
