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Social Services

Energy Assistance Application Request

Energy Assistance Application Request

Our Energy Assistance Application is temporarily closed for maintenance. Please contact us at 503-650-5640 for assistance.

October: the program is open to senior &/or disabled and medically fragile households
November: the program is also open to households with children 6 and under
December: the program opens to all Clackamas County income eligible households

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

There is a senior (60+) living in my home.

Someone living in my home has a disability.

There are one or more children aged 6 and under living in my home.

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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Chair Craig Roberts

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Commissioner Martha Schrader

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District Attorney John Wentworth

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