Project Warm All Programs Screening

You have indicated that you are filling out this application on behalf of someone else. For the remainder of the application, please answer ALL questions with the Applicant's information.

Name*

First NameLast Name

Gender*

Age*

To the best of your knowledge, have you received our First Line Weatherization services in the last 3 years?*

YesNoUnsure

Primary Phone Number*

Please enter a valid phone number.

Primary Phone Number Type*

Secondary Phone Number

Please enter a valid phone number.

Secondary Phone Number Type

Email Address

example@example.com

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is this your mailing address?*

YesNo

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What county do you live in?*

If you do not see your county listed above, it means Project Warm does not serve your area at this time.

Do you own or rent your home?*

OwnRent

Does your household receive utility service through LG&E?*

YesNo

Including yourself, how many people total live in your household?*

Do any children age 5 or younger live in your home OR spend more than 3 hours in your home at least 2 days a week? (family visits, babysitting, etc. DO count)*

YesNo

Are you or anyone who lives in your household disabled?*

YesNo

What is your household's approximate total monthly income? KTAP benefit and SNAP/Food stamps count as income.*

Across all household members age 18 or older, what source(s) does the household income come from? (Check all that apply.)*

Does your home need any specific repairs you would like to make us aware of? Please note that Project Warm may NOT be able to honor specific repair requests.

If you are eligible, how would you like to receive the full Project Warm Application?*

Mail (Physical Application)