Energy.capk.org

Forms & Applications

WEBReady to submit your application? We offer three ways to submit your application for assistance from CAPK’s Energy Program: Fax your application to (661) 336-5263; Email …

Actived: 3 days ago

URL: https://energy.capk.org/forms-applications/

Department of Community Services and Development Mail …

WEBPage 1 of 4 Department of Community Services and Development Mail ☐ Appointment ☐ Official Use Only: Energy Intake Form Utility Assistance ☐ Weatherization ☐ Priority …

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CLIENT EDUCATION CONFIRMATION OF RECEIPT

WEB— I certify that I have made a good faith effort to deliver the information to the dwelling unit listed above and that the occupant was unavailable to sign the confirmation of receipt.

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CSD 41 A.C.C.(04/2022) Agency: Intake Initials: Intake Date

WEBPage 1 of 3. First name Middle Initial Last Name Date of Birth . MM/DD/YY . SERVICE ADDRESS – Address where you live (this . cannot. be a P.O. Box) Service Address Unit …

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Total Monthly Income $ LIHEAP ACC Cert date Intake date

WEBPage 1 of 3. First name Middle Initial Last Name Date of Birth . MM/DD/YY . SERVICE ADDRESS – Address where you live (this . cannot. be a P.O. Box) Service Address Unit …

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