HEPA Vacuum Lending Request Form
Please fill out this quick form to request a HEPA Vacuum unit.
Name *
First and Last
Email *
Phone Number *
City of Residence? *
Zip Code? *
How would you prefer to be contacted by the Program Coordinator? *
What day/time are you hoping to pick up the HEPA Vacuum? *
Our office is open 9:00 AM to 5:00 PM Monday-Friday. The Program Coordinator has a flexible schedule and may be able to accommodate an early morning or evening pick up.
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Time
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What additional day/time would work for you to pick up the HEPA Vacuum? *
MM
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DD
Time
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Have you attended a Lead Poisoning Prevention or Lead-Safe Home Projects Workshop hosted by Community Energy Project? *
For most people interested in our HEPA Vacuum Lending Program, we ask that you attend one of our two public workshops about lead poisoning prevention. You can find these on our online calendar (http://www.communityenergyproject.org/get-involved/calendar/) and register for the class you prefer using the form on that webpage. If it's a more urgent need, such as you have a child or someone pregnant with an elevated blood level or have tested and found a lead hazard in the home, our Program Coordinator can work with you to set up a one-on-one workshop that will take approximately 1 hour. You will go over a condensed version of our workshops and discuss how to properly use the vacuum.
If yes, approximately when did you attend the workshop?
Month and Year
How did you hear about the HEPA Lending Program? *
Required
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