Weatherization Registration Form

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Clinton Hill Community Action, UCC, and La Casa De Don Pedro will be hosting an in-person event on Wednesday, August 31st between the hours of 12pm to 3pm. Location: 404 Hawthorne Ave., Newark, NJ 07112. Please ensure to fill out the form to its entirety and to have your documents readily available. There will be onsite assistance readily available for housing related issues and weatherization needs. To adhere to the CDC guidelines, we would like to obtain information in advance to warrant everyone's safety and comfortability.

Last Name *

First Name *

Address (house # and street) *

City *

State *

Zip Code *

Telephone number *

Email Address *

What type of assistance do you need? *

Heating/Cooling/Energy Efficiency

Lead abatement

Utilities

Housing Assistance

Other:

Which option works best for you?: *

Schedule an appointment for a later date

In-person

Submit

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