ENERGY ASSISTANCE PROGRAM – CLIENT INTAKE
Client Intake Directions
Client Intake Form
Upload Client Documents
Please click the letter according to the first-letter of the primary applicant’s last name.
Please upload scans or clear pictures of each document. Please include the primary applicant’s name in each document’s filename. The following documentation is required for each household, as applicable:
- Picture I.D. for the primary applicant.
- Social Security Cards for ALL household members INCLUDING children.
- If you do not have a Social Security number or are a non-citizen, you must provide ID for each person. Program eligibility will be determined during the application process.
- Verification of physical address.
- Verification for ALL income/monies received into the home from ALL sources and for EVERY household member for the 3-months indicated. Example: If your appointment is in December we will need proof of all income received in September, October, and November. It is recommended you bring in income information for the current month as well.
- A current heating bill for the residence.
- If you indicated “Self-Employed”, please contact our office to request a self-employment form. We will require documentation of ALL self-employment income received during the time frame indicated, i.e., business bank statements and documentation of business expenses incurred during the time frame.
- If heat source is propane, oil, or pellets, a recent receipt or delivery ticket.
- If heat source is wood, a statement from someone (a neighbor, friend, landlord, etc.) who can state that your main source of heat is wood.
- If heat is included in your rent, a statement from your landlord, a rental agreement, or lease that shows proof that heat is included in rent.
Anyone with zero (‘0’) income and who is 18 or older will be required to complete paper work explaining how he/she paid for food, shelter, and heat at the time of the appointment. If you are a student, your Financial Aid award letter is required.