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Bloomington CiviForm

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Solar, Energy Efficiency, and Lighting Program (SEEL) Eligibility Form3 of 9

Note: Fields marked with a * are required.

Point of Contact

Please provide the contact information for the authorized member or employee of the organization who will communicate with the City of Bloomington throughout the grant process.

The contact person may differ from the person filling out this form, if you are submitting on their behalf. Additional contacts may be added on the next page.

Full Name

First name *

Middle name

Last name *

Job

Title or Role

Job

Email Address

Email Address *

Phone Number

Enter phone number

For technical support, contact civiform@bloomington.in.gov