Solar Lights Program - English Version

Solar Lights Program: Household Information & Eligibility Form

Any questions? Reach out to us at 509-529-4980.
Client Information
Today's Date

MonthDayYear
Date
Name

First NameLast Name
Date of Birth of Applicant:

MonthDayYear
Date
E-mail
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Household Size
Household Annual Income
Address (must reside within city limits of Walla Walla):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you rent or own this property?
Did you already receive alley solar lights from the City of Walla Walla?
If you were to qualify for the Solar Lights Program, will you be able to install the lights yourself or will you need assistance to install the lights?
If you were to qualify for the Solar Lights Program, which lights are you interested in receiving?
Eligibility Criteria - Review the table below:
Based on your household size and annual household income, are you at or below 80% of the Area Median Income?
Program Guidelines
BMAC will not be responsible for replacing solar lights after they have been installed, unless the lights fail within the first 30 days of the installation date.
Did you read the program guidelines and agree to the terms and conditions
Signature

If you type your name below on this form, all above statements must be true.
Name

First NameLast Name
Should be Empty:

Solar Lights Program: Household Information & Eligibility Form