| Business Sector |
| Sector: |
Institutional |
| Segment: |
K-12 Schools |
| If this is Incorrect Please Select a Different Sector or Business Segment |
| Your Information |
| First and Last Name |
|
| Email Address |
|
| General Information |
| Name of Facility/Building |
|
| Address |
|
| Address - Continued |
|
| City |
|
| State |
|
| ZIP Code |
|
| Contact Person |
| First Name |
|
| Last Name |
|
| Job Title |
|
| Address |
|
| Address - Continued |
|
| Phone |
|
| Email |
|
| Fax |
|
| Mobile |
|
| Building Information |
| Year Built |
e.g.. 2001 |
| No. of Students |
|
| Hours of Building Occupancy per Week |
(when the majority of the building is being used) |
| No. of Months Building Operated per Year |
|
| Size of Building |
(Sq. Ft.)
(Do not include any unheated areas) |
| No. of Floors |
|
| School Type |
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| How is the Building Heated? |
|
| Number of Personal Computers: |
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| How is the Building Cooled? |
|
| Percentage of Building Cooled |
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| Utility Information |
| Electric Utility |
|
| Electric Utility Account No. |
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| Heating Utility |
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| Heating Utility Account No. |
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| Other Information |
What are your biggest challenges to implementing energy efficiency measures?
(Check all that apply) |
| Funding |
|
| Time |
|
| Expertise |
|
| Don't know how to get started |
|
| Staff |
|
| Or Other (Please Explain) |
|
| Number of Walk-in Refrigerator/Freezer Units: |
|
| Does the Building have a Pool? (Check all that Apply) |
|
| Indoor: |
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| Outdoor: |
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| Olympic 50x25: |
|
| Recreational 20x15: |
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| Short Course 25x20: |
|
| No. of Months per Year Pool is in Use |
|
| Building Operated on Weekends? |
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Instructions:
Complete this online Building Data Collection Form for each building and either mail or email the most current 12 consecutive months of utility bills, or a completed and signed Utility Data Release Form to:
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