Wyoming Low Income Energy Assistance Program
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To apply for the LIEAP program using the online application portal, please use the "Apply Now" button below.

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Below you will find specific forms that you may have been  asked to complete by the LIEAP office.  If so, please click ‘Download File’ to open a printable version of the form. 
​Complete the form and submit to the LIEAP office. 

Application 23-24
File Size: 493 kb
File Type: pdf
Download File

Employer Statement
File Size: 141 kb
File Type: pdf
Download File

Work Registration
File Size: 142 kb
File Type: pdf
Download File

Rental Verification
File Size: 139 kb
File Type: pdf
Download File

Self Declaration of Zero Income
File Size: 110 kb
File Type: pdf
Download File

Statement of Incapacity
File Size: 102 kb
File Type: pdf
Download File

Self Declaration of Permanently Parked Traditional Dwelling
File Size: 132 kb
File Type: pdf
Download File

Authorized Representative Release Form
File Size: 132 kb
File Type: pdf
Download File


Questions? Call us at 1-800-246-4221 for help.

Location

822 West 23rd Street
Cheyenne, WY 82001

Need help? call us!

To get information about your application or
to ask that an application be mailed to you,
​call: 1-800-246-4221.



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Wyoming LIEAP is funded by the U.S. Department of Health and Human Services and
​is administered by the Wyoming Department of Family Services.
  • Home
  • Weatherization
  • Forms and Application
  • LIEAP FAQs
  • Income Guidelines
  • News and Updates