Weatherization Assistance Program 2025 Application

This application is for Weatherization Assistance ONLY!

Our goal is to make your home energy efficient by addressing minor issues within the home.
Weatherization Assistance Program
1800 N. Valley Mills Dr.
Waco, TX 76710
254-753-0331 / Fax: 254-753-1730
weatherization@eoacwaco.org

THIS IS NOT AN ENTITLEMENT PROGRAM.
Program applications will NOT be processed unless all information is provided.

Please use the checklist below to ensure that you are providing all of the required documents:
- Income for the last 30 days for everyone 18 years and older. All Income must be dated within the last 30 (thirty) days from the day application is signed (including income for that date Award letters must show 2023 Benefits. Acceptable proof of income is as follows: *We do not accept bank statements or tax documents ** If there is no income, Please complete the Declaration of Income Form.
- Social Security Number and date of birth for Everyone in the Household (included on application)
- Utility Bills (Need copies of bills indicated below)
- Need documentation to prove US Citizenship and Identity for all in the household. To verify citizenship - A certified Birth Certificate or Two supporting documents - (See list of allowable documents) To verify identity - Texas DL or Photo ID or two supporting documents (See list of allowable documents)
- Landlord agreement with signatures and date if the residence is rented.
WEATHERIZATION ASSISTANCE IS NOT A REHABILITATION PROGRAM AND DOES NOT ADDRESS THE APPEARANCE OF YOUR HOUSE.

The Weatherization Assistance Program performs minor repairs to your home to prevent air from escaping or entering the house. Weatherization measures strive to assist you to maintain a more comfortable temperature level in your home and save you energy dollars. Homes that need weatherization will typically have cracks, holes, and other places where air leaks in and out. Here is a list of the types of work that the weatherization program may address:
- Repair or replace low energy efficient heaters
- Repair or replace low energy efficient air conditioners
- Install attic and/or wall insulation
- Repair doors
- Repair windows
- Replace broken glass and glaze around loose panes in windows
- Weather strip around doors and attic hatches
- Patch holes in the walls where air is coming in or out of the house
- Patch holes in floors and ceilings
- Caulk around window and door frames
- Wrap exposed water pipes
The weatherization program does not provide funds for painting your house, installing new carpet or vinyl flooring, or storm doors.

*How much assistance does the program provide?

EOAC is required to explain all the possible services provided by the Weatherization Assistance Program as part of its client education. EOAC has a limited amount of money that can be spent on any particular home. Therefore, the work done on each home will be different based on the condition of the home, the amount of energy used to heat and cool the residence, and program guidelines set by the Texas Department of Housing and Community Affairs. The initial assessment of your home DOES NOT guarantee that you will be eligible for weatherization services.
Applicant Information

Section A - Basic Information
Date of Application*

MonthDayYear
Date
Name of Applicant or Head of Household *
First and Last Name
Email Address*
Cell Phone Number*
Additional Phone Number
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Is your mailing address different from your physical address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
If yes, show the following on the app
Has this residence ever received services from the Weatherization Program?*

YesNo
If "yes", when?
Have you received assistance with utility bills through the Community Services Department this year?*
Is this application being submitted for assistance with a gas leak or gas water heater?*

YesNo
Request for Gas Leak/Gas Water Heater Repair

Please answer the following questions for assistance with your gas leak/gas water heater repair. This service is provided separately from Weatherization services.
We can assist with gas leaks and/or gas water heater repairs through funding made available by Atmos Energy. You must be an Atmos Energy customer and be able to provide your account number (whether it is active or inactive). The weatherization application must be completed in its entirety to request assistance for a gas leak/gas water heater repair.
Since you indicated that you need help with a gas leak or gas water heater repair, please make a selection based on your request. Do you need help with a gas leak or gas water heater repair?
You will need to complete the Request for Assistance with a Gas Leak/Gas Water Heater Repair section of this application.
Household Information

Please enter all household members and answer all questions for each member.*

	Name	Date of Birth	Sex	Race	US Citizen	Disabled	SSN	Veteran	Health Ins
1st HH Member
2nd HH Member
3rd HH Member
4th HH Member
5th HH Member
6th HH member
7th HH Member

Did your household have income for the last 30 days? (child support is not considered as income)*

YesNo
Is there anyone in your household 18 years and older who does not have income?*

YesNo
Section B

Income - Employment
Are any members of your household employed?*

YesNoSelf Employed

Section C

Additional Income (TANF, SSI, SS, Veteran Benefits, Retirement, Military, Child Support, Unemployment, Workers Comp, other)
Does anyone in the household receive additional income from other sources other than income? (TANF, SSI, SS, Veteran Benefits, Retirement, Military, Child Support, Workers Comp, Other)*

YesNo

Migrant/Seasonal Farm Worker

Please check here if you are employed as a migrant or seasonal farm worker/Por favor marque aqui si usted es empleados como un trabajador migrante or trabejador agricola estacional
SECTION D

House Information
What year was your home built?*
Do you own (buying) or rent your home?*

OwnRent
Type of house you own/buying:*

Site BuiltMobile Home
Type of house rented:*

Site BuiltMobile HomeLow Rent Federally Subsidized HousingApartmentRented RoomType (Section 8, Etc)
Type of energy used to heat household (check one):*

Natural GasBottled GasElectricityOther
Type of Air conditioning used (check one):*

NoneCentral UnitWindow UnitEvaporative Cooler
Understanding and Agreement
Signature*
Conflict of Interest
Is anyone in the household currently serving as an employee, agency, consultant, officer or elected or appointed official of EOAC?*

YesNo
If yes, identify who and their role
Is anyone in the household related to anyone currently serving as an employee, agent, consultant, officer or elected or appointed official of EOAC?*

YesNo
If yes, identify who and their role
I certify that the information on the form is correct and I also understand that receipt of assistance through misrepresentation or fraud is punishable by fine or imprisonment.
Signature*
Information Release Form
I am applying to participate in the Economic Opportunities Advancement Corporation of Planning Region XI's Weatherization Assistance Program.

EMPLOYMENT: I authorize my employer to provide any relevant information that may be required for program documentation concerning my employment.

COMMUNITY AGENCIES:  I authorize release of any relevant information that may be required for program documentation concerning my eligibility for services.

EDUCATION:  I authorize my educational institution to provide any relevant information that may be required for program documentation concerning my educational status relating to my financial aid status.

LEGAL:  I authorize release of any relevant information that may be required for program documentation concerning my legal status.
Signature*
Release of Information
I authorize EOAC Weatherization Department to release information included in my application for weatherization assistance to the following entities;
- Texas Department of Housing and Community Affairs
- The Department of Energy (DOE)
- The Department of Health and Human Services
- The Texas Association of Community Action Agencies
- Frontier and Associates
- Oncor
I further give EOAC permission to contact any source in order to solicit/verify information necessary for an eligibility determination.
Signature*
Renovate Right
Signature*
Customer Billing/Consumption Release Form
Do you have an active electric account?*
Electric Utility Company*
Electric Account Number*
Do you have an active gas account?*
Gas Utility Company
Gas Account Number
Propane Company
Propane Account Number
(You will need to provide a copy of your electric, gas, or propane bills.)

I authorize the Texas Department of Housing and Community Affairs and its contracted agency to solicit/verify information on my energy billing and consumption histories, both past and future, to the extent the information is used only to determine program eligibility and to provide data.
Signature*
Maaclink Form
Signature*
If you do not have a gas account, show this on app
Systematic Alien Verification for Entitlements (SAVE) System and US Citizenship/US National
The program for which you are applying requires verification that you are a US Citizen, a non-citizen national, or a legal resident of the United States. Documentation of your status is required. This agency uses the Systematic Alien Verification for Entitlements (SAVE) System to verify the status of non-citizens.

I am aware that I am subject to prosecution for providing false or fraudulent information.

(Please provide a copy of the birth certificate for everyone in the household and a copy of the ID or driver's license for adults 18 and older.)

By signing, I certify that the documents I am providing for citizenship verification are true and correct.
Signature*
Declaration of Income Statement

If there is someone 18 or older in your household with no income, please answer the following questions.
Please list the household member that has not had income in the last 3o days.
Gross Income Received Monthly
Would you like to add another household member?

YesNo
Please list additional household member that has not had income in the last 3o days.
Gross Income Received Monthly
Would you like to add another household member?

YesNo
Please list additional household member that has not had income in the last 3o days.
Gross Income Received Monthly
My household has no documented proof of income due to the following situation:
Please explain reason for no income:
I certify that the above information is true and correct to the best of my knowledge and belief.

I understand that the information will be verified to the extent possible; and that I may be subject to prosecution for providing false or fraudulent information.
Signature
Landlord Information

The landlord will have to complete a Landlord Agreement to receive weatherization services. Please provide landlord information and a landlord agreement will be mailed or visit our website to download the form. The application cannot be processed until we receive the landlord agreement.
Landlord Name:
Landlord Address: (Address, City, State, Zip)
Landlord Email
example@example.com
Document Submission

Please submit all documents required to process the application. You can upload more than one document.
Proof of Income for last 3o days*

Browse Files
Please upload a copy of all income (Check stubs, Social security award letter, Retirement, etc.) Cancelof
Copy of Electric bill, gas bill, or propane statement*

Browse Files
Please upload a copy of the electric bill, gas bill and/or propane statement Cancelof
Birth Certificate*

Browse Files
Please upload a copy of birth certificates for all members of the household Cancelof
ID/Driver's License

Browse Files
Please upload a copy of the ID/DL for members of the household 18 and older Cancelof
Other Documents

Browse Files

Cancelof
You are now ready to submit your application for Weatherization Services. Please ensure you have submitted all required documents in order to process your application.
Were you satisfied with the application process?
Should be Empty:

	Name of Person Working	Employers Name	Total Monthly Income
HH Member 1
HH Member 2
HH Member 3

	Person Receiving	Monthly Amount
AFDC
SSI
Social Security
Veteran's Benefits/Beneficios de Retiro
Retirement Benefits
Military Allotments
HUD Utility Supplement
Child Support
Unemployment Compensation
Workman's Compensation
Contributions/Regalos
Other

This application is for Weatherization Assistance ONLY!

Applicant Information

Request for Gas Leak/Gas Water Heater Repair

Household Information

Section B

Section C

SECTION D

Understanding and Agreement

Conflict of Interest

Information Release Form

Release of Information

Renovate Right

Customer Billing/Consumption Release Form

Maaclink Form

Systematic Alien Verification for Entitlements (SAVE) System and US Citizenship/US National

Declaration of Income Statement

Landlord Information

Document Submission