Fill - Free fillable Heat Pump Installer Training (Efficiency Maine) PDF form

Please submit by email: hesp@efficiencymaine.com OR Fax: 207-622-9933 OR Mail: PO Box 219, Brunswick, ME 04011–0219

Please allow six weeks for processing.

Rev 6.1.2021

Heat Pump Installer Training

Scholarship Claim Form

Use this form to request a scholarship of 50% of course cost up to a maximum scholarship of $500.

REQUIREMENTS:

☐ 1. Applicant is employee of Heat Pump Residential Registered Vendor company

☐ 2. Applicant has EPA Section 608 certification

☐ 3. Applicant completed the Efficiency Maine Annual Heat Pump Basics Training video

☐ 4. Applicant completed a 40-hour Heat Pump Installer Training course delivered by an Efficiency Maine

Registered Trainer

☐ 5. Heat Pump Installer Training completed within last 90 days

☐ 6. Claim Form submitted with Heat Pump Installer Training Completion Certificate stating that class meets

Efficiency Maine Heat Pump Installer Training requirements

☐ 7. Claim Form submitted with Heat Pump Installer Training proof of payment

NOTE: Program subject to change without notice.

Student Information

Name:

Address, Town, State, Zip:

Email Address:

Phone Number:

Residential Registered Vendor Company Name:

(and branch if applicable)

Heat Pump Installer Training Information

Efficiency Maine

Registered Trainer:

Course Date(s):

Course Cost:

Scholarship Request :

(50% of cost up to $500)

Signatures. Please certify that all information on this application is correct by signing below.

Student Signature:

Date:

Employer Signature:

Date:

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