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Social Services

Utility Support Application Request

Utility Support Application Request

All requests to be mailed an application are tracked in our database and addressed in the order received so please make only one request either online or by phone. Repeat requests delay the process. Applications are mailed once a week.

Indicates required field

My household is within Clackamas County.

(For households not within Clackamas County, please call 211 for information on Energy Assistance in your area.)

First Name

Last Name

Email

Phone

Secondary Phone optional

Address

Address

Address Line 2

City

State

ZIP

Mailing Address

Mailing Address (if different)

Mailing Address Line 2

City

State

ZIP

Preferred Language

Number of adults in the home over the age of 18 who have sporadic income from odd jobs, and/or an informal child support agreement, and/or zero income.

I have not received unemployment within the last six months.

I have experienced delays with claims, reduction of income, and/or have been quarantined.

I am requesting assistance with the following utilities:

Electric—PGE (Portland General Electric)

Electric - PGE Radios

I am current on my account.

I have a disconnect notice.

I am shut off.

Electric—CUB (Canby Utility Board)

Electric—CUB (Canby Utility Board) Radios

I am current on my account.

I have a disconnect notice.

I am shut off.

NW Natural

NW Natural Radios

I am current on my account.

I have a disconnect notice.

I am shut off.

Oil

Oil Radios

I currently have a supply.

I am low on my supply.

I am out.

Pellets

Pellets Radios

I currently have a supply.

I am low on my supply.

I am out.

Propane

Propane Radios

I currently have a supply.

I am low on my supply.

I am out.

Wood

Wood Radios

I currently have a supply.

I am low on my supply.

I am out.

I understand this form completion and submission will add my name to the Energy Assistance waitlist. When my name comes to the top of the waiting list, I will be mailed an application. I agree to provide any and all documentation as required to determine eligibility.

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