Regististration Form
You can register your interest for the Hepburn Z-NET Home Energy Assessments and Energy Savvy Upgrades program by filling in this form. You may qualify for a free assessment valued at about $330. A Victorian State Government subsidy valued up to $880 may also be available to help with energy-efficient upgrades to your home.
Email address *
Are you seeking help to better understand and manage your energy bills?
Clear selection
Are you interested to have a Victorian Residential Efficiency Scorecard Assessor conduct a free home energy assessment at your home, or rental property? *
Do you identify with any of the following (multiple answers ok) *
What is your name? *
Your best contact phone number? *
How would you like to be contacted? *
What is the postcode where the assessment would take place?
What is the address that the home energy assessment would take place? *
Do you have the capacity and are you willing to co-pay for a part-subsidised upgrade? The program will subsidise 50% of the cost of upgrades up to a maximum of $880. Residents or landlords will need to pay the remaining 50% of the total cost. *
What is your status in relation to the property you would like us to assess? *
Are you willing for your property to be included as a case study to help advertise this program to a wider audience online and via other media? (Not required) *
If you have any other questions, feedback or other comments, please add them here
How did you hear about our program
Please check all that applies
Social Media
Newspaper or other print media
Word of Mouth from friends, family etc
Public information session
Assessor or supplier direct
Hepburn Shire related material or staff
Radio or TV
Would you like to receive our project newsletter and other Hepburn Z-NET project related updates via email? You may opt out any time by emailing 'unsubscribe' to
Clear selection
Are you a Hepburn Wind member?
Clear selection
Never submit passwords through Google Forms.
This form was created inside of Hepburn ZNET. Report Abuse