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

Utility Assistance Application Request

We can only accept requests for applications that are submitted Monday - Friday between 4:00 PM - 7:00 PM. If you submit this request outside of those hours you will not get an application.

For all other requests please include ALL of the following information:

Do you live in Washington County, Oregon?

First Name

Last Name

Date of Birth

(MM/DD/YYYY)

Address (Line 1)

Address (Line 2)

City

State

Zip Code

Phone

E-mail Address

Total number of adults age 18 or older that reside in your home

Total number of minors, age 17 or younger, that reside in your home

Total amount of monthly income GROSS (before any taxes or deductions). This includes wages, Social Security, TANF, child support, etc.

PGE account number (if applicable)

ebwudbvm301t

Northwest Natural account number (if applicable)

Your application delivery preference

How would you prefer to receive your application?

Mail
Email (you must be able to print the application)

Preferred language of application

English
Spanish

We hope to be able to assist you with your energy needs. Please allow up to two business days to receive your application via email or 5 business days to receive it via mail. Check your spam folder as our emails might get routed there. Do not submit more than one request as all requests will be processed.