Forms & Applications

Forms and Applications to be downloaded, printed and completed:

Energy Intake Form CSD 43
Energy Intake Form CSD 43 (Español)

Client/Customer Consent Form and Authorization Form CSD 081
Client/Customer Consent Form and Authorization Form CSD 081 (Español)

Certification of Income and Expenses Form CSD 43B
Certification of Income and Expenses Form CSD 43B (Español)

Energy Service Agreement for Rental Property Owner – CSD 515C
If you are a renter, this form gives CAPK Energy Program permission from your landlord or their representative to weatherize the property.

Client Education Form (Excel Format)
Client Education Form (PDF Format)

Checklist of Energy Efficient Practices
Making the Most of Your Money

Fax your application to (661) 336-5263 or email your application to HEAPOFFICE@CAPK.ORG

Mail or Drop off application at: 300 19th Street, Bakersfield, CA 93301

An applicant must provide copies of the following documentation : Documentation must be current and dated within Six weeks of application date.

1. Current proof of household income:

  • Government aided statement – TANF/Cal-Fresh Passport to Services, Social Security, Unemployment, Veterans, Disability, and Educational.
  • Earned income – all paystubs received in the last 30 days
  • Unearned income – Child support, Spousal support, Adoption/Foster Care assistance
  • Self Employed – must have current income tax information
  • Pension/Retirement statement
  • Certification of income and expenses (43B) – if required per technician.

2. Utility Bill:

  • (Gas, Electric, Propane only) Provide all pages of your utility bill and
  • Any notices received in the last 30 days. If you have separate gas and electric companies, you must provide both utility bills.

3. Rental Agreement or Mortgage:

Rental agreement, including proof of Low Income Housing (H.A.C.K), Section 8, or Mortgage payment statement.


4. Proof of Identification Required:

Valid Social Security Card with no restrictions; State I.D; Driver’s License.


5. Client Education Form:

Click here to go back up to the Client Education Form.


*IMPORTANT: Incomplete applications will not be processed and may be denied upon receipt. If you have a 48-hour notice or your utilities are disconnected and your bill exceeds the amount you qualify for, the difference must be paid and a receipt provided prior to your application being processed. Your HEAP application is not a commitment that your bill will be paid. Therefore, you must continue to pay the amount owed on your bill. If eligible, a credit will be sent directly to the utility vendor within 90 days.

**Note: PG&E current bills are identified by a blue stripe on the top portion of the bill.  15 day & 48-hour notices are identified by an orange stripe on the top portion of the bill.

For more information you may contact CAPK HEAP at (661) 336-5203.