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Energy Assistance Program

Emergency Home Energy Forms

Here are the forms that need to be completed for assistance under the Emergency Home Energy Assistance for the Elder program. This program is income based and for anyone over 60 year of age or has a household member that is over 60. We will also need everyone's current proof of income, Fl Id's on everyone, Social Security Cards on everyone, if you receive SNAP your paperwork on that also and if you rent the rental agreement and either your late/discount notice. Theses items can be faxed to WOCOA at 850-892-8169. Please make sure that you have a phone number on the cover sheet so we can contact you


Application

Download EPSON033.PDF

Attachement N

Download attachn.PDF

Release

Download Authorization_for_Release_client waiver_8 20 15.pdf