NOTE: Please complete all necessary forms and attach all documents when submitting your application. All forms are fillable and can be saved and emailed or printed and mailed. Incomplete applications can cause processing delays. More information can also be found on our Frequently Asked Questions page.
• This form gives the NENCAP Weatherization Program basic information about you and your household.
BASIC INTAKE FORM Page 1
BASIC INTAKE FORM Page 2
• This form gives NENCAP detailed information about you and your household.
• Please make sure to fill out complete information for all members of your household. You may save/print additional copies of "Page 2" to include all household members.
CLIENT QUESTIONAIRE – WX13
• This form gives the Weatherization Crew important information about your home.
LANDLORD-TENANT AGREEMENT– WX14
Who needs to complete this form: This form must be completed for rented homes, (Not required for homeowners)
• This form gives permission from a property owner to a tenant and to NENCAP to weatherize the client home.
• This form also sets the amount of money that NENCAP can pay towards repairing/replacing furnaces and water heaters in rented homes.
CITIZENSHIP ATTESTATION – WX15
Who needs to complete this form: Every Adult Member of the Household (18+)
• This form verifies that you are a citizen or a qualified resident.
• Each adult household member must complete a separate citizenship attestation form. You must save/ print additional pages of form WX15 for each adult in your household
• This form gives NENCAP permission to weatherize your home along with other important permissions.
UTILITY CONSUMPTION RELEASE-WX22
• This form gives NENCAP and NDEE permission to obtain information from your fuel suppliers about fuel consumption. This information is used to determine your priority level.
ITEMS THAT MUST BE ATTACHED!!!
INCOME VERIFICATION - All applications must include proof of income. Further details regarding income verification can be found Frequently Asked Questions.
PROOF OF OWNERSHIP - All applications must include proof of home ownership. Proof of home ownership can consist of a deed, title, or property taxes in the owner or landlord's name.
COPY OF UTILITY BILLS - Please submit a copy of your latest utility bills (including electric and natural gas). Additionally you will need to submit a 12 month utility history showing consumption and bill amount. These can be used to verify account numbers.
You can submit the application by mail, addressing it to:
NENCAP attn. WEATHERIZATION
PO BOX 667
Pender, NE 68047
email to firstname.lastname@example.org