​These are forms you may need to complete your application to receive assistance.
Questions? Call us at 1-800-246-4221 for help.
Printable Application
File Size: 837 kb
File Type: pdf
Download File
Employers Statement
File Size: 150 kb
File Type: pdf
Download File
Work Registration Verification
File Size: 77 kb
File Type: pdf
Download File
Rental Verification
File Size: 64 kb
File Type: pdf
Download File
Self Declaration of Zero Income
File Size: 173 kb
File Type: pdf
Download File
Statement of Incapacity
File Size: 38 kb
File Type: pdf
Download File

Location

1401 Airport Parkway, Suite 300
Cheyenne, WY 82001

Need help? call us!

To get specific 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.