To apply for the LIEAP program using the online application portal, please use the "Apply Now" button below.
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.
Complete the form and submit to the LIEAP office.
| Application 23-24 |
| Employer Statement |
| Work Registration |
| Rental Verification |
| Self Declaration of Zero Income |
| Statement of Incapacity |
| Self Declaration of Permanently Parked Traditional Dwelling |
| Authorized Representative Release Form |
Questions? Call us at 1-800-246-4221 for help.