Energy Smackdown™ Intake
Exit this survey

1. Tell us about your organization

Thank you for your interest in the Energy Smackdown, a project of the BrainShift Foundation. Our mission is to support and empower individuals like yourself to transform their cities, towns, neighborhoods, schools, churches, and businesses through the use of clean and efficient energy.

To better understand how we might help you to increase participation in and improve the effectiveness of carbon reduction programs in your community, please respond to the ten questions below. ALL QUESTIONS REQUIRE ANSWERS.

The Energy Smackdown Team

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1. Please give us your contact information.

Please give us your contact information. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

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2. How is your organization organized?

	Organizational Unit	Size
Primary	How is your organization organized? Primary Organizational Unit	Size
Secondary	Secondary Organizational Unit	Size

Please explain

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3. What are the demographics of your primary organizational unit? (check all that apply)

What are the demographics of your primary organizational unit? (check all that apply) Caucasian Afri-American Hispanic Asian	Other Low income Medium income High income	Urban Suburban Rural
Please explain

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4. What are your areas of focus? (check all that apply)

What are your areas of focus? (check all that apply) Electricity

Natural gas

Transportation

Waste

Food

Other

Please explain

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5. What would you like help with? (check all that apply)

What would you like help with? (check all that apply) Getting deeper energy savings

Increasing participation in efficiency programs

Team formation and support

Data tracking and scoring

Organizing challenge events (ie light bulb challenge, travel challenge, etc.)

Media and visibility

Raising funds and attracting sponsorship

Video production

Other

Please explain

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Energy Smackdown™ IntakeExit this survey

1. Tell us about your organization

*1. Please give us your contact information.

*2. How is your organization organized?

*3. What are the demographics of your primary organizational unit? (check all that apply)

*4. What are your areas of focus? (check all that apply)

*5. What would you like help with? (check all that apply)

Energy Smackdown™ Intake
Exit this survey

*
1. Please give us your contact information.

*
2. How is your organization organized?

*
3. What are the demographics of your primary organizational unit? (check all that apply)

*
4. What are your areas of focus? (check all that apply)

*
5. What would you like help with? (check all that apply)