MEAP Self Sufficiency Plan Application

  • Household Information

    Attach extra pages if you need to include additional members. List everyone who lives in your home, including adults and children temporarily absent due to illness or employment. People are considered members of your household if they sleep and keep their belongings in your home. Be sure to include the date of birth and citizenship status for each member.






  • Enter the names and relationship to you of any other persons living in the household.














  • Household Address (Service Address)



  • Mailing Address, if different than above



  • Additional Information Needed

    Home Heating Credit (HHC): Have you applied for or received the HHC (Energy Draft) in the last 6 months?

  • Have you received energy assistance from another agency or through a provider- sponsored program since October 1?



  • Electric (non-heat) Provider Information



  • Heat Provider Information

  • *Electric heat sources include solar panels, boilers, radiators, or baseboard heating but DO NOT include space heaters





  • Propane/Fuel Oil Information (if applicable)

  • Wood Information (if applicable)





  • General Questions



  • Digital Signature Requirement

    Please sign below after reading the following information, otherwise this application will be considered incomplete



  • Affordable Payment Plan



  • Digital Signature