Community Action Council
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Forms

Energy Forms

  • Heat Source Statement
  • Heat Bill Responsibility Form
  • Self Employment Income Worksheet
  • RV Proof of Residence Form

Weatherization Forms

  • Landlord Packet
    • Tenant Rights
    • Owner/Agency Agreement Information
    • Landlord Information Letter
    • Proof of Home Purchasing
    • Wall Insulation Consent Form
    • Non-Maintenance Agreement
    • Property Owner/Agency Agreement
  • Homeowner Packet
    • Owner/Agency Agreement Information
    • Applicant Information Letter
    • Proof of Home Purchasing
    • Wall Insulation Consent Form
    • Non-Maintenance Agreement
    • Homeowner Authorization
  • Qualifying Packet
    • Qualifying Packet

* You may need to install a PDF reader on your system to be able to read the files above.

What’s New

  • Amazon SmileShop with Amazon Smile!March 4, 2015 - 3:00 pm
  • New Phone SystemMarch 4, 2015 - 2:55 pm

Contact Us

Multiple Locations
Voice: 360.438.1100
Fax: 360.491.7729
Toll Free: 800.878.5235

Additional Programs

  • Community Engagement
  • Health
  • Housing
  • Hunger

Women, Infants & Children (WIC)

Monarch CJAC

© Copyright 2015 - Community Action Council of Lewis, Mason & Thurston Counties
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