Weatherization Application

Client/Partner Login
SNAP Email Sign Up
Donate to SNAP
Classes & Events

Home
About Us
Services
Locations
Donate to SNAP
Employment
Successes
Volunteering
Media Center
Partners / Links
Sitemap
Contact

SNAP
3102 W. Fort George Wright
Spokane, WA 99224
(509) 456-7111
Fax: (509) 534-5874

Weatherization Application

If you need weatherization assistance, please fill out the form below and a member of the SNAP weatherization team will review the information.

Location Information

Please fill out the address information below.

Full Name: *

Address: *

City: *

State: *

Zip Code: *

Home Phone: *

Work Phone: *

E-mail address:

Best time to contact you?:

Did you receive Energy Assistance (EAP) last season from SNAP?: *

Yes

Household Information Section

How did you hear about our program? : *

Tell us how you heard about the program. Please keep it short and sweet.

Total number of people in the household?: *

(How many people actually live within the home)

Do you live in a mobile home?: *

Yes

Do you live within a mobile home park?: *

Yes

Do you rent or own your home?: *

Rent

Own

If you rent; how many units are in your building?:

Is your rent subsidized?: *

Yes

Unknown

What do you pay for rent or for your home mortgage?: $ /month

Landlord Information

If you rent; please enter your Landlord’s information.

Full Name:

Address:

City:

State:

Zip Code:

Work Phone:

Approx. Monthly Income of Household: * $ /month

Source of Income: *

Place of employment or other financial income source.

Heat Information Section

Local Utility Company: *

Utility Account: * #

Please enter the account number from your utility statement.

Heat Type: *

electric

gas

oil

propane

wood

other

Please select at least one heating option.

Heating Equipment: *

furnace

baseboard

wood stove

other