Please fill out this commitment with recipient only after going through Education Worksheet.

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* 1. First Name

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* 2. Last Name

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* 3. Is this participant an Xcel customer?

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* 4. Preferred Language

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* 5. Zip Code

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* 6. Which One Time Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet)

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* 7. Which Everyday Action will you take to lower your gas or electric bill? (If appointment is in-person, have them write these actions on their magnet)

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* 8. Do you commit to checking your energy use each month to understand how your actions are affecting your gas or electric bills?

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* 9. How do you typically view your energy bill?

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* 10. Was this appointment...

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* 11. Energy Outreach Colorado (the non-profit that funds this program) would like to reach out to you to offer additional tools, support and seasonal reminders. Please provide e-mail address and mobile number that receives texts (if any). Provide mailing address for those without email or mobile phone.

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* 12. Mailing address for those without mobile phone/email address.

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* 13. Additional comments from appointment

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