Energy Assistance Form

Energy Assistance Application



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Welcome To MDC's Energy Assistance Program

This program season is active from October 1st, 2025 - September 30, 2026, while funding lasts.

Before You Begin: 

  • The application takes an average of 10-25 minutes to complete, depending on your household size.  
  • You'll need to upload all required documents to submit your application.
  • We recommend saving your documents to your device before starting for a smoother experience.

For Income Limits and Required Documents please visit our website.

How can we reach you?


Numbers only (no dashes, spaces, or symbols).



Important!
This program requires that at least one (1) household member is a U.S. Citizen with a valid Social Security Number. You may still be eligible for other benefits such as a Utility Discount Program, for more information click HERE. 
Urgency

Your energy source(s) must either be disconnected or have a CURRENT shutoff notice to choose the 2nd or 3rd option.


Only provide if you have also received a disconnect notice or are shut off on your secondary energy account.
About You



Home Address

Please use the placeholder address' format. There is a 29-character limit; please abbreviate longer address as appropriate.





Mailing Address

Please use the placeholder address' format. There is a 29-character limit; please abbreviate longer address as appropriate.


two-letters only

My Home
Housing Types



(MM/DD/YYYY)

Do not include $ sign. If you are on subsidized housing, only include the amount you are responsible for.

Heat With Rent Verification









Please enter a decimal number without any $ sign.




Please enter a decimal number without any $ sign.
Energy Accounts File Upload

Required to receive help from the PSE HELP program.

If your primary heat source is propane, oil, or wood, please upload a receipt or invoice.

If your secondary heat source is propane, oil, or wood, please upload a receipt or invoice.
Primary Applicant



(MM/DD/YYYY)


9 digit SSN (no dashes).
Demographics







Primary Applicant File Upload


Primary Applicant Income Information

Including standard employment, unemployment, self-employment, pensions, SSI, SSA, TANF, Child Support, VA, Military, or any other income.
No Income Attestation

Can be as simple as "lost job," "full-time parent," etc.

Using savings, relying on food banks, etc.


Your income documents must reflect the income from the previous month. For instance, if you are applying in October, the income provided should cover all of September.
Income history (Earned Income)
You must enter a whole number greater than 1. Do not include $ sign.

Please ensure you reference the Pay Date or Advice Date for accurate dates, NOT the pay period.

If you only have 1 paystub for the entire previous month, please upload the same file here.


Income History (SSI)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (SSA)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (Pension)
You must enter a whole number greater than 1. Do not include $ sign.

Pension verification letter, etc.
Income History (Self-Employed)
You must enter a whole number greater than 1. Do not include $ sign.

W-2, bank deposit, etc.
Income History (Unemployment)
You must enter a whole number greater than 1. Do not include $ sign.

Letter on unemployment verification, etc.
Income History (TANF)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (General Assistance)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (VA)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (Military)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.
Income History (Child Support)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.
Income History (Other)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.

Rental income, etc.

Additional Household Members
Important!
You answered that you rent a room in a home. For this next section, only include individuals who share your living space in your shared home. 

The page may take a few moments to load after making your selection.
Important!
Please complete this section for each Household Member *other than yourself*. 

All household members 18 or older must complete their own income section(s) attesting to their respective income(s). 

If you forgot someone, at the bottom of this page is an "Add Another Household Member" button that will allow you to repeat this section for each household member. 







(MM/DD/YYYY)


9 digit SSN (no dashes).
Household Member Demographics







Household Member File Upload


Household Member Income Information
This household member must complete their own income section.

Including standard employment, unemployment, self-employment, pensions, SSI, SSA, TANF, Child Support, VA, Military, or any other income.
No Income Attestation

Can be as simple as "lost job," "full-time parent," etc.

Using savings, relying on food banks, etc.


Your income documents must reflect the income from the previous month. For instance, if you are applying in October, the income provided should cover all of September.
Income History (Paycheck/Salary)
You must enter a whole number greater than 1. Do not include $ sign.

Please ensure you reference the Pay Date or Advice Date for accurate dates, NOT the pay period.

If you have only one paystub for last month, upload it again here.


Income History (SSI)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (SSA)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (Pension)
You must enter a whole number greater than 1. Do not include $ sign.

Pension verification letter, etc.
Income History (Self-Employed)
You must enter a whole number greater than 1. Do not include $ sign.

W-2, bank deposit, etc.
Income History (Unemployment)
You must enter a whole number greater than 1. Do not include $ sign.

Letter on unemployment verification, etc.
Income History (TANF)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (General Assistance)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (VA)
You must enter a whole number greater than 1. Do not include $ sign.

Award letter, statement of benefit change, etc.
Income History (Military)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.
Income History (Child Support)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.
Income History (Other)
You must enter a whole number greater than 1. Do not include $ sign.

Bank deposits, etc.

Rental properties, cash jobs, etc.

If you are eligible for secondary benefits, they will appear here; otherwise, please continue to the next page. 
Secondary Benefit Possible - Shelter Assistance 

If eligible and you and your landlord agree to separate terms, we can pay your past due balance up to $1,000. 
Tenant and Landlord are responsible for making payment arrangements for any remaining balances after assistance is provided.  







Weatherization Assistance Possible
What is the Weatherization Assistance Program? Our Weatherization Assistance Program offers free services and repairs to improve energy conservation and increase home health and safety. The program provides professional energy management services that may include, insulation upgrades, air sealing, and other energy-saving improvements. 


Cooling Assistance Possible
Eligible LIHEAP households may receive one air conditioner unit from the program every seven program years. Please note that review and distribution of these units may not begin until late spring. We kindly ask for your patience and request that you refrain from calling in regard to your status. You will receive an email with your decision once your eligibility has been reviewed. Supplies are limited, and agreeing to the terms and conditions does not guarantee the availability of a unit.

You are not eligible to receive an air conditioner unit. Please move on to the next page to continue with your energy assistance application. 

*Supplies limited. Indicating interest does not guarantee a unit can be procured.
Air Conditioner Terms and Conditions, Unit Specifications, and Operating Requirements:
  • The unit is a free-standing portable unit, weighing approximately 55-70lbs with dimensions approximately 18 inches by 15 inches wide and up to 36 inches tall. It does not sit in a window.
  • The unit must be plugged into a wall socket and set up on a level surface near a window.
  • The main part of the unit comes fully assembled but includes a hose and window connectors that must be attached or assembled before the unit can be operated.
  • Upon delivery and during periods of non-use, the unit should be stored upright. Portable AC units must sit upright for at least 24 hours prior to use.
  • The unit requires light periodic maintenance including cleaning air filters and draining any moisture accumulation.
  • The unit will include a user manual with additional information and instructions.
  • The unit is for recipient’s household use only.
Additional Important Terms:

We are using a third-party to distribute the unit to you and we will have them deliver it to the shipping address you designate below. Upon delivery, the recipient takes over all responsibility for the unit, including but not limited to movement, assembly, installation, and proper use.

We make no warranties for and accept no responsibility in connection with the use of the unit. In
addition, we are not responsible or liable for any defect, damage, accidents, or injuries resulting
from handling or operating the unit, whether as directed by the user manual or otherwise. Please
refer all comments, concerns, replacements or other requests about the unit to the unit manufacturer, including any defects, damages, or malfunction issues. We cannot assist with any of these matters. We are providing the unit to you as a one-time benefit. Clients can only receive one unit every seven (7) program years. We will not provide additional or replacement units.





Water / Sewer Assistance

If eligible and funds are available, we will lookup your Water/Sewer balance with TPU and pay your past due balance up to $2,500.
You must agree to the terms below and electronically sign this form to complete your application. 
Release of Information:

Metropolitan Development Council is partnered with the Department of Social and Health Services' Benefit Verification System. We need your permission to access some of the information that the Benefit Verification Service electronically stores about you.

By giving your permission, we will be able to see the following information about you:


  1. Basic demographic information including name, age, and household members;
  2. Verification of different benefits received already such as Cash Benefits, Food, or Medical;
  3. The amount you receive for each benefit;
  4. A list of benefits received in the past 3 months;
  5. Your household's earned and un-earned income;
  6. Child care copay amounts, child's name & provider information; and
  7. Certification periods.

This permission is to access information only. MDC will have no authority as an authorized representative nor be allowed to share or re-disclose information accessed to other parties.  

LIHEAP Terms & Conditions
LIHEAP, which stands for Low Income Home Energy Assistance Program, is a federal program that helps low income households pay for heating or cooling their homes.  In most states, it also helps people make sure their homes are more energy efficient by paying for certain home improvements, known as weatherization.
 
Most states will use LIHEAP to help you pay for your energy bill for heating or cooling your home and offer additional help in cases of energy crisis. A number of States may also offer weatherization services.

I certify that I have provided and reviewed all information on each page of this document and it is accurate to the best of my knowledge. I understand that I may be subject to criminal prosecution if I have knowingly provided false information. I further understand that I may request a Fair Hearing if the provision of the above information is not acted on to determine my eligibility within a reasonable time or if I do not receive benefits for which I feel I am eligible. I give my permission for this agency and Washington State Department of Commerce (COMMERCE) to request/release necessary information that may result in my receiving benefits from this assistance request and from similar and related programs administered by the State of Washington, including food assistance. I also give the above listed heating vendor(s) permission to establish a line of credit, and/or to release my account information to this agency or COMMERCE for current and future data analysis and eligibility determination. If the vendor is Tacoma Public Utilities, the permission to release customer billing and consumption information is allowed for up to six months from the date of this application. I understand that provision of my social security number is necessary to avoid duplicate energy assistance benefit payments to the same applicant household.  I hereby authorize energy program staff to also use my social security number for income verification purposes (including Employment Security Unemployment Insurance and DSHS Food Assistance). I further authorize this agency and COMMERCE to use my personal information within their organizations for the purpose of identifying and reporting unduplicated non-personal applicant data.

PSE HELP Terms & Conditions
I certify that I have provided and reviewed the above information, which is accurate to the best of my knowledge.  I understand that I may be subject to criminal prosecution if I have knowingly provided false information.  Additionally, I hereby authorize Puget Sound Energy, Inc. ("PSE"), this Agency, and Washington State Department of Commerce (COMMERCE) to exchange and release, disclose and make available to each other, information about me, my use of PSE products and services and/or my application for or participation in the PSE HELP program. This includes any information furnished or disclosed by me to this Agency herein or otherwise and any other information necessary or useful in assessing, documenting or confirming my eligibility or ineligibility to receive PSE HELP benefits (including Employment Security, Unemployment Insurance and DSHS Food Stamp benefits) or for current or future data analysis. I do so with full knowledge that this information is or may be confidential and as such will be protected from unauthorized disclosure. I understand that this authorization may be revoked at any time by written notice to PSE and this Agency. Until such time as I do so revoke this authorization in writing, however, this authorization shall remain in full force and effect and PSE, this Agency, and COMMERCE may rely on this authorization in exchanging, releasing, disclosing and making available to each other all such information.

Energy Saving Tips Acknowledgment
Below are a few ideas to help you save money and use less energy. To qualify for LIHEAP, you must acknowledge that you have read these tips.

  • Unplug electronic devices when not in use or when leaving home
  • Consider investing in a power strip to easily turn off multiple devices 
  • Turn off lights in rooms that aren’t being used
  • Reduce your refrigerator’s temperature (36 to 38 degrees) 
  • Make sure appliances are turned off after each use
  • Consider replacing bulbs with energy efficient lighting (CFL and LED lightbulbs)
  • Seal drafts in windows and doors with weather stripping, caulking, or plastic film 
  • Avoid using space heaters as much as possible, as they are expensive, unsafe, and not the most energy efficient when it comes to heating your entire home
  • Vacuum vents and heating baseboards regularly 
  • Add light colored curtains to windows and keep shades open during the day for sunlight and closed at night to keep warm air in
  • Consider installing a water saving shower head 
  • Lower water heaters thermostat to 120 degrees
  • Dust light fixtures regularly 
  • Take showers, not baths 
  • Run the dishwasher with full loads only and let dishes air dry 
  • Lower the thermostat every time you leave the house
  • Wash full loads of laundry with cold water, air dry clothes, and clean lint trap
  • Raise the heat temperature in your home gradually, since sudden increases will substantially increase your energy usage

Optional Survey




Other Comments



Select all that apply
Almost There!
The next page is to review your application and to provide your E-Signature. If your application is successfully submitted, you will receive a confirmation email (make sure to check your spam folder).

You will receive a decision by email once your application has been reviewed. An Energy Coordinator will contact you only if additional/missing information is needed. In the meantime, we recommend continuing to make regular payments to your account until your application is approved and the pledge is posted/received.

Please Note: Application review and payment processing may take some time. We appreciate your patience as we work to assist all households as quickly as possible.