Home Energy Assistance Program (HEAP)

Please complete the form below to review eligibility for HEAP

County Social Services District*

Program Year*

2024-2025

SSD Worker - Full Name*

SSD Worker Phone Number*

SSD Fax Number*

SSD Worker Email Address*

Vendor Name*

Case Number*

Client Full Name*

Account Number*

Client Address*

Customer Tank Level*

Please Take the Following Action*

Enter Dollar Amount For Option Above*

Type a question*

SCHEDULE AN
APPOINTMENT TODAY