Wayne County Action Program Application Package

Manufactured Housing Requires:
Park Name:
Park Owners Name:
Address (where rent check is submitted):   Street Address      City   State   Zip
Phone Number:      Phone Number
Park Managers Name:
Phone Number:      Phone Number

If yes, and the issue is severe, refer them to bishop sheen.

Do you know the weekly, monthly or yearly income? If so, add numbers below.
Weekly Income
Monthly Income
Yearly Income

Finger Lakes Community Action Weatherization Forms

Go over income guidelines to make sure client is eligible.

If applicant receives HEAP/SNAP it makes them automatically eligible. For HEAP everyone in the house must be on the award letter. For SNAP only one person must be receiving. Let applicant know that they need this documentation at appointment.

If client has electric or gas bill available, fill out the following information:

ELECTRIC UTILITY: If you are responsible for the bill, provide the following:

GAS UTILITY: If you are responsible for the bill, provide the following:

Dwelling Conditions

Whole Home Energy Audit Questions

Grant or House Rehabilitation Services Information

Household Information

Household Member Information

Eligibility Checklist

Appointment Scheduling