If you would like to apply for this program, please provide your name, email address, phone number, and zip code below, and you will be notified once the application is available.
By providing this information:
- You agree that you have read this entire page, or had it read to you in a language that you understand.
- You agree that you would like to be contacted regarding this program.
- That you are providing correct and current contact information for your household. (If the information provided is incorrect or no longer current, we may not be able to contact you).
- You agree that by completing this form, you have not applied for this program and doing so does not guarantee an award of the benefit. You will need to complete the official application process and meet the program requirements to receive the benefit.
You understand that any future benefit is subject to sufficient funding being available to the Commonwealth.
If you need help with completing this form or need to request a reasonable accommodation to provide your name and contact information, please call the Cold Relief Heatline: (800) 632-8175.