2021 Summer Cooling Assistance Application

2021 Summer Cooling Assistance Application

Cheyenne and Arapaho Tribes Elder Care Program

eldercare@cheyenneandarapaho-nsn.gov

Concho Office
P.O. Box 133, Concho, OK 73022
405-422-7411, Office Phone
1-800-247-4612 ext., 27411
405-422-8230, Fax

Clinton Office
P.O. Box 714, Clinton, OK 73601
580-331-2317, Office Phone
405-422-8229, Fax

· 1 Electric Bill per household will be processed for the summer cooling assistance. Electric Bill will be the only bill paid during this time up to $100 on CURRENT AMOUNT only.

· If you are on AVERAGE/BUDGET/LEVELIZED BILLING, we will pay towards billing plan up to $100.

· Pre pay accounts will receive $100 in electric bill assistance.

· No past due, disconnects, reconnections or deposits allowed.

· If you have a “ZERO” or “Credit” balance, NO payment will be made.

· Must submit your complete current electric bill, if bill is not in your name, you must have a 2021 Residence Verification form on file.

· This incentive will exclude street lights, yard lights, security lights.

· Please allow additional time to process check request.

· **Does not affect your 90-day assistance** **Last day to submit a bill is the day it is due**

Name *

First Name Last Name
Always provide your CDIB# *
Spouse's Name

First Name Last Name
Date of Birth *

Month Day Year
Date
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Message Phone *

Area Code Phone Number
Electric Bill *

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Please provide a scanned copy of your bill. A picture of the bill will not be accepted. Cancel of
2021 Summer Cooling Assistance Application
Electric bills accepted beginning September 1, 2021-October 11, 2021
**No applications/bills will be accepted after October 11, 2021**
If you have any questions, please contact our office at 405-422-7411
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