Upload Supporting Documents for Your Application for Financial Help to Heat or Cool Your Home

• Part 1 - Enter Contact Information
• Part 2 - Documents Submitted

Part 1 - Enter Contact Information

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First Name

Middle Name

Last Name

Home Address (Or address you are moving to)

Apt#

City

State

Zip Code

Is the Current Mailing Address the same as the Home Address listed above?

Yes

No

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Mailing Address (If different from home address)

Apt#

City

State

Zip Code

County Of Residence

Office: {Office}

Address: {Address}

City State Zip: {CityStateZip}

Phone Number: {PhoneNumber}

If you have problems uploading any of your attachments, please send email to {Email}

 

Email

Phone Number

County Email

Part 2 - Documents Submitted

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Please attach supporting documents for your existing LIHEAP application.

Attach

Total Attachment Size: 0 MB / 10 MB

Total Attachment Size: 0 MB / 10 MB Over the limit, please reduce total attachment size to be under 10.

Total Attachment Size

Document Name

Attachment Comments

Add Row

Remove Row

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Submit

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Thank you for submitting your application for the Low Income Home Energy Assistance Program (LIHEAP).  Below you will find information on how long it might take to process your application.  If you have any questions or would like a status update, please contact your local LIHEAP agency.

LIHEAP agencies:

https://dss.mo.gov/fsd/energy-assistance/pdf/liheap-contracted-agencies.pdf

Your Form ID is: {formuniqueid}.

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