HomeWise Weatherization

Do you live in the City of Seattle? *

This application will take an average of 30 minutes to complete. You need to create an account to save progress. You can return to the application later if needed. If you do not create an account, your information will not be saved. *

Do you see your name at the top right-hand side of the screen? *

Please enter your current address. *

Please check the box if this is your primary residence. *

Please upload a copy of one of the following documents to verify your home address. The document you upload must be recent and show your full legal name. Accepted documents include current Seattle City Light bill, current Puget Sound Energy bill, mortgage payment receipt, current lease, or rental agreement from your landlord. *

Please enter your first and last name *

Please enter your 10 digit phone number. *

Email address *

Would you like to add a second applicant to your application? *

Are you a Puget Sound Energy (PSE) customer? If yes, please enter your Puget Sound Energy (PSE) account number.

Are you a homeowner or renter? *

Enter the full name for each household member starting with yourself. *

Have you received weatherization services previously? *

Does anyone in the household have Asthma?

How did you hear about this program?

Is the primary applicant a single female head of household?

Please enter the total number of household members who have a disability.

What is your preferred language? *

By signing below, I certify that the information provided in this application and the required documentation is complete and accurate. I understand that I may be subject to criminal prosecution if I have knowingly provided false information. I give the City of Seattle permission to request or release information to other non-profit or government organizations to assist me. This information may include but is not limited to, my application including income and related documentation, photographs showing the before and after condition of my home, and Weatherization’s scope of work. Such information may result in my receiving or being denied other City assistance.
 

For state weatherization programs: I understand that I may request a Fair Hearing if the information I have provided above is not acted on to determine my eligibility within a reasonable time or if I do not receive benefits for which I am eligible. I give the City permission to enroll me in all City or King County assistance programs for which I am eligible.
 

The utility company(s) may release past and future use information on my household to the City of Seattle’s Office of Housing (OH) HomeWise Weatherization Program. If I am eligible for service, I permit OH, its staff, and contractors to gain access to this property for audit, installation, and inspection purposes. In the case that work requires later inspection from Seattle City Light or the State of Washington, I agree to provide access for these audit purposes. *

Please enter the date you signed this form in the format month/day/year *