Community Action : Programs : Utility Assistance & Energy Conservation : Assistance Request

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Utility Assistance Application Request

Please fill out the following request to receive your utility assistance application.

Preferred language of application

English
Spanish

Para este formulario de solicitud en español click here

Do you live in Washington County, Oregon?

Yes
No

You must live in Washington County.

First Name

Last Name

Date of Birth

(MM/DD/YYYY)

Phone

Email address

Application sent by mail, please allow up to two weeks to receive your application.

Mailing Address (Line 1)

6b4bwnuv882r

City

Zip Code

Utility Assistance & Energy Conservation

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