This is to be used to apply EmpowerU Case Management only. If you submit this form to apply for utility assistance, it will be shredded upon receipt.

Applications missing any of the documents listed below will not be accepted.

1. Driver’s license Photo ID for all household members 18 and older

2. Last 30 days proof of income for household members 18 and older

• Examples: check stubs, Pension/Retirement benefit letter, TANF/SNAP letter, Unemployment Benefits, Child Support, VA Disability Award letter, 2025 award letter for Social Security, SSI,
  Bank statement and tax forms are NOT accepted. 
• If self-employed, please request a Statement of Self Employment form from our office.
• If any household member 18 or older has not received income within the last 30 days, the Declaration of Income Statement on page 4 must be completed.
  

The program for which you are applying requires verification that you are a U.S. 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 OR passport 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.

My household has no documented proof of income due to the following situation. 

 Please explain the reason for no income. 

I certify that the above information is true and correct ti 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. 

I authorize the Texas Department of Housing and Community Affairs and its contracted agencies to solicit/verify information on my energy billing and consumption histories, both past and future, to the extent that the information is used only to determine program eligibility and to provide data.

Warning: Section 1001 of the U.S. code makes it a criminal offense to make willful false statements of misrepresentation to any Department or Agency of the U.S. as to any within its jurisdiction. Release to be renewed only if the application changes. I understand that a photocopy of this release is as valid as the original.

• The information provided is true and correct to the best of my knowledge and belief.
• My household income has been annualized at the time of application according to pre-established procedures.
• I understand I may appeal a denial of eligibility, and amount of assistance received, or a delay in service delivery.
• I authorize the Texas Department of Housing and Community Affairs (TDHCA) and its contracted agencies to solicit or verify information on my utility and/or fuel bills, both past and future to the extent the information is used only to provide data relevant to my application for assistance.
• I am aware that I am subject to prosecution for providing false, misleading, or fraudulent information.

I hereby give my permission to the Economic Opportunities Advancement Corporation for the following, and do affirm the stated understandings:

• EOAC may obtain information to complete my application for assistance or services.
• EOAC may share necessary information with other individuals or organizations to provide case management services and/or secure resources on my behalf.
• I understand information will only be shared Standard Information Release EOAC may use my success story, likeness, recording, both audio and video in public relations efforts, and may share same with other entities with or without personal identifying information when doing so shall be for the good of improving community development.
• I understand EOAC may use my likeness and/or success story in releasing annual report information to State and Federal entities, and in doing so, will provide every assurance that personal identifying information will be redacted.
• I understand I am not entitled to any compensation for any use of my story or likeness.
• I will continue to provide income information for Case Management reasons for as long as necessary for EOAC to release me from the EmpowerU Program.

I hereby certify that I am disabled as defined in one of the following:

• 7(9) of the Rehabilitation Act of 1973
• 1614 (a) (3) (A) or 223 (D) (1) of the Social Security Act
• 102 (7) of the Development Disabilities Services and Facilities Construction Act (38 USC Chapter 11 or 15)

Under penalty of perjury, I have provided truthful information in this certification. In Texas, under Sec. 37.101 of the PENAL CODE, it is a felony of the third degree to falsify this information.

I hereby certify that the information above is true and accurate, and that the termination of utility services would be life- threatening to those individuals.

This notice is to inform you that you will be terminated from EOAC programs immediately for the following offenses if committed by you, the applicant, or any household member:

1.  Belligerent or threatening behavior toward a staff member or any other person(s) while inside or outside any EOAC office.
2. Verbal abuse, including the use of profanity at or in the presence of a staff member or any person(s), while inside or outside any EOAC office.
3. Any type of actual physical confrontation toward a staff member or any other person(s) while inside or outside any EOAC office.
4. Providing a false or misleading information regarding any household member(s
5. Theft from agency or staff member or any other person(s) while inside or outside any EOAC office. Theft is also identified as not returning EOAC funds refunded by an energy company.
6. Violation of EOAC concealed and open carry handgun and firearm policy.

I Acknowledge that once terminated, I will not be allowed to reapply for any services with EOAC for a period of 1-2 years depending on the severity of the violation, and the ban from services will remain in effect even if the person(s) who committed the violation moves out.

I acknowledge that all documentation of the violation will be maintained in my client file, and that I shall have the right to appeal in writing to the Program Director within 10 days of the violation.

Applicant has a responsibility to:

• Provide required information to verify eligibility for assistance whenever the case is opened or reopened
• Report any changes in the household – income, number of people in the home, etc. which may affect eligibility.
• Report any changes in utility provider when receiving utility assistance.

You can do something to keep your electric bills at their lowest by following these simple steps.

1. Thermostat setting: You can reduce your air-conditioning cooling cost by as much as 14% simply by increasing the thermostat setting by 1 degree. For energy conservation, we recommend a 78-degree setting.
2. Insulation: Insulation is designed to keep heat out during the summer and to keep heat m during the winter. Adequate insulation can more than pay for itself in just a few years, with money saved on air- conditioning and heating operation.
3. Let it breathe: Dirty filters cause unnecessary strain and can lead to equipment breakdowns. Air conditioning servicemen say about half of their trouble calls are traced to dirty filters. We suggest changing or cleaning your filters at least once a month, preferably every two weeks for the best results.
4. Maintenance: Have your unit checked and cleaned each year to ensure maximum efficiency and long life. Have the coils checked and cleaned to see if they are dirty and check the refrigerant for charge and belts for wear and adjustments.
5. Efficiency: If your unit is 10 years old or older a new, properly sized, high efficiency system should be installed.
6. Don't forget your ducts: You can save 5% or more on your atr conditioning costs by having your duct system checked for air leaks and for adequate insulation.
7. Attic: Attic temperatures sometimes rise to 140 degrees during the summer months. Good attic ventilation will lower the temperature and reduce cooling requirements inside the home.
8. Air leaks: You can save up to 10% on air-conditioning costs with a well-sealed house. Seal leaks around doors, windows, outlets, switch plates, and plumbing outlets. Weather stripping will make your home more comfortable too.
9. In the shade: If your house has a lot of windows, particularly on the east and west sides, you save money by shading the window with awnings, solar screens, or shutters. Trees and shrubs that shade your home also help to reduce the air-conditioning workload. Venetian blinds or drapes are helpful as well.
10. Turn it on: By using kitchen and bathroom exhaust fans to remove excess heat and moisture, you can save each month on your overall cooling bill.
11. Lower is better: You can save money on your water heating bill by setting the temperature control at a moderate 140 degrees, or as low as needed, and still have plenty of hot water.
12. Up the chimney: If you close your fireplace damper during the summer and winter, (when not in use), you save on both your cooling and heating bills. Installation of a glass fireplace screen will also help prevent air from going up the chimney.

Please note that this submission will be for EmpowerU applicants only. If this application is submitted an an application for any other EOAC program, it will be discarded.