Financial Assistance Program Application

$5 monthly bill discount – 12-month renewing approval period

Please complete this form and provide documentation showing current eligibility for an established income-qualified assistance program, such as Medicaid, LIHEAP, or OPALCO Energy Assist, or any other that you receive. Program space is limited and completed applications are processed in the order received.

Key dates: Apply by October 15, 2026. If approved, your monthly discount begins with the bill you receive in November. Please call our office number with any questions during business hours: (360) 376-2127

Financial Assistance Program Application

Member Information:

Service Address *
Service Address
City
State/Province
United States
Mailing Address
Mailing Address
City
State/Province
United States

Eligibility Verification

Please Verify
If receiving assistance currently, check the type of assistance documentation you are providing:

Maximum file size: 52.43MB

Payment Status

Is your EWUA account currently past due?
If yes, are you currently maintaining an approved EWUA payment plan?

ACKNOWLEDGEMENT:

I certify that the information provided in this application is accurate to the best of my knowledge. I understand that approval is subject to program eligibility, available funding, and EWUA program rules. If approved, the $5 monthly discount will remain in effect for up to 12 months, after which I may reapply.