APPLICATION INSTRUCTIONS

Thank you for your interest in the North Carolina Weatherization Assistance Program Applying for Weatherization services is easy AND FREE

ELIGIBILITY REQUIRED DOCUMENTATION: 
Please submit application along with the required verification documents (use checklist below to determine what documents we need) ANY application that is not completely filled out and failure to provide the required documents will delay the application process.  If you need help completing this application contact us at (704) 872-8141.

**All adult members of the household must sign the application and release information form; and submit a photo identification card (i.e. NC valid drivers license or ID card issued by the State).

HOUSEHOLD INCOME DOCUMENTATION

Income information for all individuals in the household must be provided and cover a 12 month period from the date of application.  This would include minors who receive SSA, SSI or have a part - time job.  (We cannot accept bank statement as proof of income) Submit ALL benefit / income that apply to each HOUSEHOLD MEMBER. 

1. Most recent Federal Income Tax returns (including W - 2 copies) and copies of pay stubs for the last 2 - months (including YTD pay)

2. Copy of final pay stub, if lost of employment in the last 12 - months. 

3. Schedule C or F with complete Income Tax return for all self - employed household members for the last 2 - years and Either most recent signed and dated quarterly or YTD profit and loss statement. 

4. Documentation of worker's compensation and unemployment benefits for the last 12 - months. 

5. Social Security benefit award letter (SSA and SSI) must cover a period of 12 - months. 

6. Retirement, Pension, IRA, Dividend, or Annuity income history for the last 12 - months

7. Documentation of Alimony, TANF, Work First, child support, or OTHER income history for EACH household member for the last 12 months. 

8. No income for the last 12 - months from any source a notarized statement is required The form is provided by the agency and it must be requested.

PROPERTY OWNERSHIP DOCUMENTATION - The following documents may be accepted:

1. Property Tax Notice / Statement or 

2. Deed recorded and stamped at the county court house

3. Certification of Title for a Mobile home If the land or property where the mobile home is located is not owned by
same person, proof of ownership for the land must be provided. 

FOR RENTERS ONLY: The owner is required to provide proof of ownership, complete the Landlord Participation Agreement form and include a copy of the rental lease agreement This form is provided by the agency and it must be requested.

FUEL / UTILITY CONSUMPTION HISTORY

12 - months of fuel / energy consumption history from each fuel / utility company that service your dwelling.  The information must include days in the billing cycle, date the meter was read, cost and consumption for the last 12 months This information can be obtained by calling your electric company or your heating fuel supplier and request a 12 - months consumption history

CLICK "NEXT" TO COMPLETE THE APPLICATION

WEATHERIZATION APPLICATION

Please complete all sections, sign and date where applicable

DWELLING OWNER INFORMATION
** RENTERS ONLY ** 
MUST INCLUDE LANDLORD PARTICIPATION AGREEMENT

OFFICE USE ONLY:

HOUSEHOLD DEMOGRAPHIC & INCOME INFORMATION                    **ALL persons living in the dwelling MUST be reported**                **ALL Income earned by ALL household members for the last 12 MONTHS must be reported**           
                                                                                                                            First, start with the person applying

AUTOMATIC ELIGIBILITY CERTIFICATION
A household automatically meets income eligibility requirements if any member of the household has received income from the Temporary Assistance for Needy Families (TANF) Program or Supplemental Security Income (SSI) within 12 months of the date of this application if either income type applies to your household, please indicate the type and provide documentation:

DWELLING / HOUSEHOLD CHARACTERISTICS

AUTHORIZATION TO RELEASE INFORMATION

VERIFICATION OF INFORMATION AUTHORIZATION

I have applied for assistance from the Weatherization Assistance Program, part of I-CARE, Inc.  As part of considering my household for assistance, I-CARE, Inc. may verify information contained in my application of services and any documents provided in connection with the request for assistance. 

I, as an applicant for weatherization services, hereby authorize the verification of any and all information, including, but shall not be limited to:
      -Employment or income records;
      -Benefit Statement/Award Letters on Social Security, Supplemental Security Income,       Veterans Administration, and/or other federal, state or local agencies;   
      -Documentation of unemployment benefits, worker's compensation, pensions, annuity, child support;
      -Fuel/Energy Consumption
      -Property owner/Present landlord information

I understand and agree, that pursuant to federal law, identifying information provided by me for determination of my household eligibility for weatherization assistance will be considered confidential and, unless otherwise authorized or required by law, will be used only for purposes directly relation to the administration of the North Carolina Weatherization Assistance Program

MEDIA/PHOTO AUTHORIZATION

MEDIA/PHOTO AUTHORIZATION 
I grant permission to the Agency listed above, the NC Department of Environmental Quality, and its agents or employees, to use any photographs that it has obtained about me due to my participation in the NC Weatherization Assistance Program.  This information may be used for a variety of purposes by I - CARE, Inc., the US Department of Energy and NC Department of Environment and Natural Resources, Division of Energy, Mineral, and Land Resources.  It may also be used by news media ; other state, local and federal agencies ; and other public or private organizations.

I waive any right to royalties or other compensation arising from or related to the use of the information I hereby agree to release and hold harmless I-CARE, Inc., the U.S. Department of Energy and NC Department of Environmental Quality, and its agents or employees, from and against any claims, damages or liability arising from or related to the use of the information.

I have read this release before signing below, and I fully understand the contents, meaning and impact of this release.