Get On The Monroe County Weatherization Waiting List Today!

Please advise, this is not an application
Date:
No heat situation?
(If yes, contact HEAP)
How did you learn about our services?
What town do you live in?
Do you own or rent?
Has your home ever been serviced by us before?
If yes, when?
What program(s)?
Annual Gross Household Income:
Household size:
Sources of income:
Is there anyone in you household:
Over 60?
Over 75?
6 or under?
homebound / disabled?
Does anyone in your household receive SSI, Public Assistance, Food Stamps or HEAP?
Did you receive HEAP benefits in the last two years?
Will you receive HEAP benefits this year?
Did you have your furnace repaired or replaced by HEAP in the last year?
What type of fuel do you use for heating?
Name and Address:
Phone number:
Contact Person (If diffrent from above):
Phone number:
Relationship:
Comments:
Email:
WAP - Intake Form
400 East Avenue Rochester, NY 14607
Phone Number: (585) 442-2030
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Submit the form below to reserve a place on the Weatherization Waiting List for Monroe County. Please list any additional questions or requests in the comments section below.
Programs and Team Information
EmPower Program Details
Weatherization Details
Home Performance Program
Assisted Home Performance Program
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OwnRent
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Child Support
Pension
Interest
Alimony
Employment
Unemployment
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YesNo
YesNo
YesNo
YesNo
YesNo
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YesNo
Gas
OIl
Electric
Propane
Kerosene
Other