city of beaverton pause form : Utility Assistance & Energy Conservation : Programs : Community Action

If you believe you are eligible for this program please fill out the form below and attach any necessary documents.

Name as it appears on your bill

Address as it appears on your bill

City, state and Zip

Mailing address if differnt

City, state and Zip

Number of people that live in your household

Please provide full name and birthdates for all living in home.

Resident status

please select all you would like to apply for

I am a customer of Beaverton Water company

Water Account Number

If not applying for water enter "NA"

Customer number

Garbage/ Recycling co.

Garbage account number

If not applying for Garbage enter "NA"

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Phone Number

Are you fleeing Domestic Violence and need your address kept confidential?

Email Address

Please upload any documents that show income verification for everyone in your household for the last 60 days showing you meet income guidelines

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Utility Assistance & Energy Conservation

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