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Energy Assistance Program – Registration Form

September 16 @ 9:00 am - December 31 @ 5:00 pm

About Energy Assistance Program

  • Provides financial assistance to low-income households to maintain utility services during the winter heating season
  • 2024-2025 program will include assistance with electric, heating, and water
  • This assistance is for financially struggling families, and income qualification will be checked

Please complete the registration below.

Please note that this is only a registration/sign-up form. After completion, by first-comes-first basic, we will call you to give you the date and time for your appointment.

Mah hi Registration/Sign-up form lawng asi mu. First-comes-first basic in Appointment pek ding ah kan in (phone) awh than te lai.

ကျွန်ုပ်တို့ကို ဆက်သွယ်သည့်အတွက် ကျေးဇူးတင်ပါသည်။ ချိန်းဆိုထားသည့်အချိန်ကို ပေးရန်အတွက် ကျွန်ုပ်တို့သည် (First-comes-first basic) သင့်ထံ မကြာမီ ဆက်သွယ်ပါမည်။

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Name
Address
How many people are in your family that live with you (your household size)?
Your available days and times (Please check one or any of your typical viabilities for the next several weeks).
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Details

Start:
September 16 @ 9:00 am
End:
December 31 @ 5:00 pm
Event Categories:
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Website:
https://thebaci.org/events/

Venue

4925 Shelby St, Indianapolis, IN 46227