This page contains a variety of helpful resources and commonly used forms. Download and review these forms before contacting us.

*************The Online Application Portal (CALIHEAP) is temporarily unavailable. You may download and complete the application below and submit by:*******************

E-Mail: heap@sjgov.org

Fax: 209-932-2649

US Mail: Energy Program, PO Box 201056, Stockton CA 95201

Self Service Drop Box: 333 E. Washington Street, Stockton CA 95202

Low Income Home Energy Assistance Program Online Application

• Online Application Portal (CALIHEAP)
• Online Application Guide

APPLICATION PACKETS (NOTE: Required to apply for all programs)

Low Income Home Energy Assistance Program (LIHEAP) Application (Complete this application to apply for HEAP and Weatherization, or all three programs together: HEAP, Weatherization, and Water Assistance.)

• LIHEAP Application Guide ( English , Spanish , Video )
• LIHEAP Application Packet (PY 2022)
• LIHEAP Documentation Checklist

Low Income Home Water Assistance Program (LIHWAP) Application (Complete this application to apply for Water Assistance only.)

• LIHWAP Application Packet (PY 2022)
• LIHWAP Documentation Checklist

APPLICATION REPLACEMENT FORMS (NOTE: To be used individually as needed. To apply for services, you must complete an application packet.)

HEAP and Weatherization Forms

• CSD-43 Energy Intake Form (English)
• CSD-43 Energy Intake Form (Spanish)
• CSD-600 Statement of Citizenship or Non Citizen Status for Public Benefits Rev-3-24-06
• CSD-81 Consent Form English
• CSD-81 Consent Form Spanish
• CE CSD-321 2022 Acknowledgment Form (English)
• CE CSD-321 2022 Acknowledgment Form (Spanish)
• CSD-43B Certification of Income and Expenses - ENGLISH
• CSD-43B Certification of Income and Expenses - SPANISH
• LIHEAP Statement of Financial Support 3.0
• Application Referral Source
• PG&E CARE Online Enrollment
• Home Energy Conservation Tips
• Make a Budget Worksheet
• CSD-51 SWEATS Intake Form (For use only during declared extreme weather conditions)

Weatherization Forms

• Weatherization Intake Form
• Weatherization Intake Form - Spanish
• CSD-515A Energy Serv Agreement - Occupant-2-12-16392
• CSD-515B Energy Serv Agreement - Prop-Owner-2-12-16798

Water Assistance Forms

• CSD-41 LIHWAP Intake Form (English)
• CSD-41 LIHWAP Intake Form (Spanish)
• CSD-43A LIHWAP Intake Addendum Form (English) [Complete this form if you have a pending HEAP application or if you received a HEAP Benefit in the past 120 days.]
• CSD-43A LIHWAP Intake Addendum Form (Spanish)
• CSD-040 LIHWAP Landlord/Management Agreement

Other Forms

• Service Referral and Follow-Up Summary
• SOC341--Report Elder Abuse Form
• SOC342--Report Abuse for Financial Institutions
• Community Center Rental Application