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Energy Request an Energy Assistance Appointment

To request an energy assistance appointment please fill out and submit the form below or call the Energy Assistance Hotline at 509-962-0435. Please do not submit your request more than once.

Due to the high volume of requests, it may be over two months before you receive a notification card in the mail indicating the date and time of your energy assistance appointment.

You will be required to bring a number of documents to the appointment. The documents will be listed on your appointment card, but it is strongly recommended that you review what you will need to bring by clicking on the "FAQ" tab and reading the information listed under "Energy Assistance."
Before filling out the form below, please click on our
Privacy Statement

Energy Assistance Request Form

First Name:
Last Name:
Mailing Address:
Unit #:
City:
State:
Zip Code:
Telephone:
Comments:
and...
Please let us know how you heard about the program:
Newspaper, Friend, DSHS, Food Bank, Flyer, Etc.
 
Have you received a disconnect or 24-Hour shutoff notice and/or do you have less than 10 days left of your primary heat source (e.g. oil, propane, wood, etc.?) Yes No

(If you answer "Yes" to this question you will be required to bring your shutoff notice to your appointment!)