*The Energy Assistance Program is no longer accepting
Applications for the 2014-2015 Program Year will be available in October 2014.
By completing and submitting this application you understand the following:
- Submitting a mail-in application does not stop a disconnect notice nor does it guarantee assistance. You must continue to pay your bill.
- You will not receive the assistance approval letter until after January 2, 2014.
- It can take 4-6 months before the payments to appear on your utility bills.
- If you are disconnected or move before the moratorium date of December 1, 2013, you will not be protected from disconnection for non-payment.
- You MUST have the EAP application returned to the CANI office by April 15, 2014. You must schedule an appointment if you fail to submit the mail-in application by this date.
- CANI is no longer able to verify your Social Security Income or Social Security numbers. You must make a copy of your current Social Security award letter, or a copy of your bank statement if you have direct deposit for your Social Security, and submit this with your EAP application.
- You must also submit a copy of every family member’s social security card, or submit proof, from Social Security Administration of everyone’s social security number.
In order to process your application, you must complete the following:
- Please complete each area on the Energy Assistance application.
- You must send a copy of your CURRENT electric and gas bill.
- Please sign and date all forms.
- You must provide proof of income for the past 12 months for all household members over the age of 18. Anyone over 18 with no income must submit a Zero Income Verifications form and a Wage History Statement.
- If you are renting, you must submit the included Landlord Affidavit.
Only send copies of required documentation. No copies will be returned to you.
Please call (260) 423-3546 and select the option for Energy Assistance General Questions if you have questions regarding early application.
You must provide your own postage.
Mail the application to:
PO BOX 10570
Fort Wayne, IN 46853-0570