Wyoming Low Income Energy Assistance Program
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To apply for the LIEAP program using the NEW online application, please use the "click here to apply" 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
File Size: 451 kb
File Type: pdf
Download File

Employers Statement
File Size: 158 kb
File Type: pdf
Download File

Work Registration Verification
File Size: 159 kb
File Type: pdf
Download File

Rental Verification
File Size: 150 kb
File Type: pdf
Download File

Self Declaration of Zero Income
File Size: 128 kb
File Type: pdf
Download File

Statement of Incapacity
File Size: 116 kb
File Type: pdf
Download File

Self Declaration of Permanently Parked Traditional Dwelling
File Size: 150 kb
File Type: pdf
Download File

Authorized Representative Release Form
File Size: 151 kb
File Type: pdf
Download File

Change of Address
File Size: 142 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 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.
  • Home
  • Weatherization
  • Forms and Application
  • LIEAP FAQs
  • LIHWAP FAQs
  • Vendors
  • News and Updates