Fuel Assistance Forms

This page contains Fuel Assistance and Utility Hardship forms.

Submit forms via:

Fax: 413 772 2733
Mail: PO Box 1432 Greenfield MA 01302
Drop-off: Blue box outside 393 Main St, Greenfield, MA
Portal: https://www.toapply.org/CA
Email: if emailing, please use encryption for sensitive information and documents. Please email to fuelassistance@communityaction.us
Need copies first? Make an appointment to see us: https://calendly.com/fuelassistance

Fuel Assistance

Wage Match AddendumDownload
Wage Match Addendum SPANISHDownload
Wage Match Addendum KREYOLDownload
Additional Household MemberDownload
Additional Household Member SPANISHDownload
Additional Household Member KREYOLDownload
Child Support-AlimonyDownload
Child Support Alimony SPANISHDownload
Child Support Alimony KREYOLDownload
Financial Assistance StatementDownload
Financial Assistance SPANISHDownload
Financial Assistance KREYOLDownload
Low Income No IncomeDownload
Low No SPANISHDownload
Low No KREYOLDownload
No Mortgage-No Homeowners InsuranceDownload
No Mortgage SPANISHDownload
No Mortgage KREYOLDownload
Odd JobsDownload
Odd Jobs SPANISHDownload
Odd Jobs KREYOLDownload
Proxy AuthorizationDownload
Proxy SPANISHDownload
Proxy KREYOLDownload
SEU QuestionnaireDownload
SEU Questionnaire SPANISHDownload
SEU Questionnaire KREYOLDownload
Utility-Deliverable Fuel Bill in Name of Person Outside the HouseholdDownload
Utility-Deliverable Fuel Bill in Name of Person Outside the Household SPANISHDownload
Utility-Deliverable Fuel Bill in Name of Person Outside the Household KREYOLDownload
Zero IncomeDownload
Zero Income SPANISHDownload
Zero Income KREYOLDownload

Utility Hardship

Berkshire Gas Financial Hardship formDownload
Eversource Gas and Electric Financial Hardship formDownload
National Grid Financial Hardship formDownload