LIHEAP App 

UESF Logo














Address






Your income (do not include other household members)







Household Members








Household Income

















(Choose the type of energy that heats your home or is being used if your main heating source is not working.)






Weatherization includes home insulation and heating system evaluation.













Additional Financial Assistance






Please upload the following documents:



"This application is being completed in connection with the receipt of Federal assistance. Program officials may verify information on this form. I am aware that deliberate misrepresentation may subject me to prosecution under applicable State and Federal statutes. I am also aware that I may not receive CSFP benefits at more than one CSFP site at the same time. Furthermore, I am aware that the information provided may be shared with other organizations to detect and prevent dual participation. I have been advised of my rights and obligations under the program. I certify that the information I have provided for my eligibility determination is correct to the best of my knowledge.

I have been advised of my rights and obligations under the program. I certify that the information I have provided for my eligibility determination is correct to the best of my knowledge.  I authorize the release of information provided on this application form to other organizations administering assistance programs for use in
determining my eligibility for participation in other public assistance programs and for program outreach purposes."