Welcome to the Utility Assistance Program Eligibility Form!

• SoCal Edison and SoCal Gas offer a utility assistance program for eligible households. Funds are limited per program period and distributed on a first-come first-serve basis.

• Eligible households may receive up to $200 towards an exising SoCal Edison bill and up to $100 towards an exisiting SoCal Gas bill while funds are available.

• For energy assistance, eligible households may receive assistance once per 12 months.

• For gas assistance, eligible households may receive assistance once per program period.

Which of the following utility assistance programs would you like to apply for? *

Energy Assistance Fund (EAF)

Gas Assistance Fund (GAF)

Both EAF & GAF

Is SoCal Edison your electric utility provider? *

Yes

Is SoCal Gas your gas utility provider? *

Yes

Do you have a separate gas bill? *

Yes

Client Eligibility Information

• In order to determine eligibility we require information on your household size and total household income for all members.

• If eligible, we will ask you to provide income documentation to attach with your UAP application.

First Name *

Last Name *

Are you the person listed on the bill? *

Yes

Please provide us with the number of members residing in your household (including yourself) : *

How many household members are over the age of 18 (including yourself)? *

How many household members have an income (including yourself)? *

Please provide us with your total household monthly income (include all income for anyone residing in your household in the total) : *

How Can We Contact You?

Our office address:

• 1887 Business Center Dr. Suite 3A, San Bernardino, CA 92408

What is your preferred language?

Phone Number *

Email Address *

Which method of communication do you prefer? *

Are you available for an in-person appointment at our office? *

Yes