SIREN Home Visit Questionnaire
This form is used to request a personalized one-on-one visit by a SIREN volunteer to your home (or business) to assess the potential for a solar energy system. Please provide the information requested below to make our site visit as productive as possible.
NOTE: SIREN is an all volunteer group, it may be a few business days before we send an initial response to your request.
Sign in to Google to save your progress. Learn more
Contact Information
We do not share this information with anyone.
Name *
Email *
Providing an email address will enable us to contact you about scheduling a site visit. If you do not use email then enter dummy@sirensolar.org, and provide a phone number below.
Phone *
Providing a phone number will enable us to call you to schedule a site visit if you prefer a phone call over email. Those without access to email must provide a phone number.
Property Address *
Please provide a street address, so we can research the site on Google Maps or Indiana GIS Maps.
City *
Please enter the city where the property is located, so we can research the site on Google Maps or Indiana GIS Maps.
Zipcode *
Please enter the zipcode where the property is located, so we can research the site on Google Maps or Indiana GIS Maps.
Electricity
⚠️NOTE: Duke offers up to two years of past bills online (you can choose "NO" to on-line paperless billing), see: https://www.duke-energy.com/home/billing/billing-payment-options
Annual Electric Usage (KWh) *
Please enter the annual kilo-watt-hours (kWh) used by your home. You can usually find this on your Duke bill (see image below), or by adding 12 months worth of electricity usage (in kWh) from utility bills.
Note that we are not asking for the $ amount you spend per year (that is later).
Captionless Image
Annual Electric Cost ($)
Please enter the approximate dollar cost of electricity for your home each year.
Utility Company
Please enter your Electric Utility Company
All Electric Home? *
Most homes in Indiana use natural gas for house heating, and electric for the rest. Please tell us if you live in an all electric home.
Annual Gas Usage
Optionally, enter the annual Natural Gas or Propane used by your property. Indicate the units (CCF, Therms, or Gallons).   Note that we are not asking for the $ amount you spend per year.
Building Information
Roof Age
How old is the roof on your home?
Roof Material
Please select your home's roof material.
Clear selection
Energy Improvements?
Tell us about energy improvements you may have done already; examples:  an energy audit by a Monroe County Energy Challenge volunteer or your Utility Company; replaced all bulbs with LED or CFL; added insulation to your attic or other parts of your home; installed high efficiency replacement windows; drive an electric or hybrid vehicle.
Wrapping up
Solar/Energy Efficient Home Tour?
Please indicate if you would be interested in visiting the home of a SIREN volunteer which has a solar energy system, and/or other energy efficiency improvements.
Sign up for the SIREN Discussion Forum:
Do you want to sign up for SIREN's email Discussion Forum?  You can ask questions, or read posts about solar energy developments.  SIREN is a non-profit solar energy organization that has been "Helping Hoosiers "Go Solar'" since 2007, in part by providing solar Site Visits. To subscribe, click on the email address/send an e-mail to:  forum+subscribe@sirensolar.org (subject/content of the email can be blank).
How Did You Hear About SIREN/Site Visit? *
Use the pull-down menu to indicate how you heard about SIREN and our Site Visit Form (check all that apply).
Required
Other Information
Let us know if there are other details about your home relevant to our site visit. For example, if you have a swimming pool or a hot tub.
For Internal Use - Please do not modify
Submission Origin *
The response to this question is pre-selected based on the website from which you fill out this form - please do not modify!
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This form was created inside of Center for Sustainable Living (CSL).