# NPTHA Climate Pollution Reduction Grant (CPRG) Residential Energy Program Application > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/tribal%3Anez_perce%3Aa51afba0cbb1bf6f ## Record - **Collection:** Tribal code - **Document type:** Tribal code ## Text NPTHA Climate Pollution Reduction Grant (CPRG) Residential Energy Program Application PO Box 188 Lapwai, ID 83540 P: (208)843-2229 F: (208)843-2973 Email: chloet@nezperce.org Application cover page The program will provide Wood Stove Change Outs (WSCO) (WOOD STOVES HAVE TO BE 20 + YEARS OLD) and weatherization services (including, but not limited to, home energy audits, sealing air leaks, exterior wall installation, window and door stripping, limited window replacement, minor roof repair, air source heat pump installs, etc.) for qualifying homes to improve indoor air quality, reduce safety hazards, and increase energy efficiency for participating households. Our goal is to reduce greenhouse gas emissions in residential homes. Who qualifies: • Tribal homeowners/renters who live within the Treaty of 1863 Nez Perce reservation boundary PRIORITY: • Nez Perce Tribal elders 62+ • Nez Perce Tribal homeowners • If you have a safety concern regarding your heating and/or cooling Please turn in the following: Copy of Tribal documentation Copy of homeownership documentation If renting, provide copies of proof of residence and landlord ownership documentation HOMEOWNER A homeowner may complete this application on their own behalf. The homeowner’s signature is required for program eligibility, approval, and authorization of services. RENTER If the applicant is a renter, both the renter and the homeowner/landlord must complete all applicable sections of this application. The homeowner/landlord must complete and sign the required certification section of this application as a condition of eligibility and program approval. We will contact you regarding the status of your application within two weeks of receiving your completed application. Contact us if you need assistance completing this application. Approved on: 3/10/26 0 General information DOB Homeowner Enrollment number Facebook Messenger name First & Last Name Tribe Phone/Cell Email Mailing Address Physical Address Directions to your home Renter Landlord information (if renting) Landlord name Landlord email Landlord phone/cell Year of home Type of home Stick built Do you have electricity? Do you have a heat pump? Type of cooling: Do you have homeowners’ insurance? General home information Square footage of home Manufactured Single wide Other: Yes No Electricity Provider (Include account number) Yes No Do you have baseboard heating? Yes No General concerns: Do you have a Smoke + Carbon Monoxide (CO) alarm or smoke alarms? If yes, what year? Weatherization information Have you had a home energy audit? Yes No If yes, what year? Have you had any weatherization upgrades? If yes, what kind? (some examples: insulation or weather stripping) Yes No Yes No Yes No What type of weatherization is needed in your home? Do you own an air cleaner? Yes No If yes, how often M T W Th F S do you use it? Hours a day: 1 2 3 4 5 Wood stove information Yes No If yes, year of wood stove No If yes, why? Do you have a wood stove? Do you believe your Yes wood stove is a fire hazard? Rank your wood stove (highest number being most hazardous): 1 2 How long do you dry your Weeks 1-3 months 3-6 months firewood before burning? How/Where do you get NPT Wood Cut your Purchase wood? program own wood 3 Su 6 7 4 5 6-12 months Other: 8 Never More than 12 months 1 Where do you store your firewood? Stacked in Pile on the Stack off the Other: the shed w/ ground w/ tarp ground and roof covered List ALL household members here, enter the head of household on the first line. First & Last Name Date of birth Tribal Affiliation Source of income Are there any household members who are disabled in your home? Yes If yes, please list Wood stove question: Does the person building the fire/operating the wood Yes stove have any ADA accessibility needs? (location of air control/damper handles) Do any of your household members have a lung, heart or blood condition? Yes Additional information: HOMEOWNER CERTIFICATION Signature clause No No No Homeowner Certification (regarding consent) Please initial each item below to indicate your consent regarding access, education, photo/video and weatherization (note: additional contracts may require further authorization): Access _____I agree to allow the NPTHA CPRG Residential Energy Program employees access to my home for necessary initial assessments and post assessments, including the duration deemed necessary during contractual work. _____ I agree to provide reasonable access to my home for the NPTHA CPRG Residential Energy Program’s approved contractors to complete all approved weatherization work deemed necessary. _____Furthermore, if I’m unable to be present, I will inform the NPTHA CPRG Residential Energy Program of further access to my home for both the NPTHA CPRG Residential Energy Program employees and approved contractors. Consenting to this may be verbally and/or written. This portion is to avoid any delay in providing work completion. Education _____I acknowledge and agree to receive education and informational materials provided through the NPTHA CPRG Residential Energy Program, including but not limited to topics related to weatherization, wood stove change outs, energy efficiency measures, and the reduction or elimination of greenhouse gas emissions. Photo/Video _____I acknowledge that the NPTHA CPRG Residential Energy Program will take photographs and/or video of my home and surrounding areas on my property for program documentation purposes. 2 Weatherization _____I agree to allow the NPTHA CPRG Residential Energy Program’s approved contractors to install an air intake, which may require cutting a hole in a wall and/or floor as necessary for proper airflow for safe and effective wood stove operation. (The hole will be sealed according to code) _____ I agree to allow the NPTHA CPRG Residential Energy Program’s approved contractors to install an air source heat pump if needed, to allow heating/cooling for my household, which will require cutting a hole in a wall for proper installation. _____ I agree to allow the NPTHA CPRG Residential Energy Program staff to install a Smoke + Carbon Monoxide Alarm and Smoke Alarms as needed. _____Additionally, I authorize the NPTHA CPRG Residential Energy Program to access my utilities to gain information pertaining to monthly usage throughout the term of this grant. I certify that I am the legal owner of the property listed above or have the legal authority to approve the work described. I understand the scope of work may involve structural modifications necessary to complete weatherization improvements safely and effectively. I understand that the NPTHA CPRG Residential Energy Program is relying on this information to verify my household’s eligibility for program assistance. I certify that all information and answers to the questions contained in this application are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility including minors who reside in the home. I understand that providing false information or making false statements is considered grounds for denial of my application. I also understand that such action may result in criminal penalties. I authorize my consent to have the program verify information contained in this application for purposes of providing my eligibility for assistance provided by the program. I will provide all necessary information including source(s) of income, names, addresses, phone numbers, where applicable and any other information required for expediting the application process. I understand that the processing of this application will require providing personal information to the program. I understand that acceptance is agreeing and abiding by applicable program requirements and policies as they now exist or as they may hereafter by be revised OR ADDED by the program. Printed homeowner name: Homeowner’s signature: Date: (ONLY COMPLETE THIS PORTION IF YOU OWN A WOOD STOVE) I certify the following under the penalty of perjury by signing below: I understand that providing false information on this application constitutes fraud and will include, but is not limited to, disqualification from participating in this project and from future wood stove change outs. My existing wood stove is currently located at the physical address provided above. It is operable and regularly used as our main source of heat. I understand that the new device must be installed by a NPTHA CPRG Residential Energy Program participating vendor and installer. I understand that I may not keep or sell the old wood stove, and the installer will take the old wood stove to an approved recycling facility. I agree not to replace this new heating device with a non-certified wood stove or other solid fuel device during the 3 expected lifetime of this new device. I will operate this new heating device in accordance with the manufacturer's instructions and will follow proper burning practices received from the Participating Vendor and EPA Burn Wise educational materials. I understand that proper stove installation, operation, burning practices, and yearly maintenance are critical to the effectiveness of this new device. I will not burn pressuretreated wood, garbage/trash, plastic, or any other prohibited materials. For wood stove/inserts, I will only burn clean, dry natural firewood (seasoned for at least 6 months) or commercially designed fire logs approved for wood stoves in this new device. I understand that the NPTHA CPRG Residential Energy program does not warrant any devices purchased under this program, including, but not limited to the quality, functionality, or satisfaction of the device. All warranties are through the stove manufacturer and installer. I agree to hold harmless the NPTHA CPRG Residential Energy Program, employees, and agents from all loss, damage, or liability that arises out of or is in any way connected with installation or use of the device installed under this program. I agree to allow access to my home to the NPTHA CPRG Residential Energy employees and contractors performing the woodstove changeout. I certify the statements and information in this homeowner application are true, accurate, and complete. Printed Homeowner name: Homeowner’s signature: Date: RENTERS ONLY Signature clause Please initial each item below to indicate your consent regarding access, education, and photo/video (note: additional contracts may require further authorization): Access _____I agree to allow the NPTHA CPRG Residential Energy Program employees access to my home for necessary pre and post assessments and contractual work. _____ I agree to provide reasonable access to my home for the NPTHA CPRG Residential Energy Program’s approved contractors to complete all approved weatherization work deemed necessary. _____Furthermore, if I’m unable to be present, I will inform the NPTHA CPRG Residential Energy Program of further access to my home for both the NPTHA CPRG Residential Energy Program employees and approved contractors. Consenting to this may be verbally and/or written. This portion is to avoid any delay in work completion. Education _____I acknowledge and agree to receive education and informational materials provided through the NPTHA CPRG Residential Energy Program, including but not limited to topics related to weatherization, woodstove changeouts, energy efficiency measures, and the reduction or elimination of greenhouse gas emissions. Photo/Video _____I acknowledge that the NPTHA CPRG Residential Energy Program will take photographs and/or video of my home and surrounding areas on my property for program documentation purposes. Weatherization _____Additionally, I authorize the NPTHA CPRG Residential Energy Program to access my utilities to gain information pertaining to monthly usage throughout the term of this grant. 4 _____ I agree to allow the NPTHA CPRG Residential Energy Program staff to install a Smoke + Carbon Monoxide Alarm and Smoke Alarms as needed. I understand that the NPTHA CPRG Residential Energy Program is relying on this information to verify my household’s eligibility for program assistance. I certify that all information and answers to the questions contained in this application are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility including minors who reside in the home. I understand that providing false information or making false statements is considered grounds for denial of my application. I also understand that such action may result in criminal penalties. I authorize my consent to have the program verify information contained in this application for purposes of providing my eligibility for assistance provided by the program. I will provide all necessary information including source(s) of income, names, addresses, phone numbers, where applicable and any other information required for expediting the application process. I understand that the processing of this application will require providing personal information to the program. I understand that acceptance is agreeing and abiding by applicable program requirements and policies as they now exist or as they may hereafter by be revised OR ADDED by the program. Printed Renter name: Renter signature: Date: (ONLY COMPLETE THIS PORTION IF YOU LIVE IN A HOME WITH A WOOD STOVE) I certify the following under the penalty of perjury by signing below: I understand that providing false information on this application constitutes fraud and will include, but is not limited to, disqualification from participating in this project and from future wood stove change outs. My existing wood stove is currently located at the physical address provided above. It is operable and regularly used as our main source of heat. I understand that the new device must be installed by a NPTHA CPRG Residential Energy Program participating vendor and installer. I understand that I may not keep or sell the old wood stove, and the installer will take the old wood stove to an approved recycling facility. I agree not to replace this new heating device with a non-certified wood stove or other solid fuel device during the expected lifetime of this new device. I will operate this new heating device in accordance with the manufacturer's instructions and will follow proper burning practices received from the Participating Vendor and EPA Burn Wise educational materials. I understand that proper stove installation, operation, burning practices, and yearly maintenance are critical to the effectiveness of this new device. I will not burn pressuretreated wood, garbage/trash, plastic, or any other prohibited materials. For wood stove/inserts, I will only burn clean, dry natural firewood (seasoned for at least 6 months) or commercially designed fire logs approved for wood stoves in this new device. I understand that the NPTHA CPRG Residential Energy program does not warrant any devices purchased under this program, including, but not limited to the quality, functionality, or satisfaction of the device. All warranties are through the stove manufacturer and installer. I agree to hold harmless the NPTHA CPRG Residential Energy Program, employees, and agents from all loss, damage, or liability that arises out of or is in any way connected with installation or use of the device installed under this program. I agree to allow access to my home to the NPTHA CPRG Residential Energy employees and contractors performing the wood stove changeout. I certify the statements and information in this homeowner application are true, accurate, and complete. Printed Renter name: Renter signature: Date: 5 FOR OFFICE USE ONLY Below this line: Program representative Signature Printed name: Signature: Verification of Tribal documentation received: Yes Proof of residence received: Yes Approved Not approved Reviewed by: Date: No No Date rec’d: Date rec’d: Incomplete Application Deferred (Waiting list) Date: Comment: 6 --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/tribal%3Anez_perce%3Aa51afba0cbb1bf6f. Public record. Not legal advice.