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HomeWise Weatherization

Provides energy efficient improvements for renters and homeowners.

17 of 18 Applicant Acknowledgement

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

The information you provide will be used for the purpose of reviewing your application. The City of Seattle may share the information you provide with City of Seattle departments for the purpose of providing you with information on additional programs for which you may be eligible. If you provide consent to enroll in an additional program for which you are eligible, the City of Seattle may also share the information with City of Seattle departments to enroll you in the additional program. We will not knowingly share your information for enforcement purposes of any kind or for any other reason unless compelled by law. To learn more, please see the Public Records Act (RCW Chapter 42.56). The City of Seattle Privacy Statement explains how we handle the information you give us.

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