Applying for THAW assistance is as easy as 1,2,3: YOU CAN ...

1 Dear Friend,The Heat and Warmth Fund (THAW), a leading provider of energy assistance , wants to make it easier for you to get the help you need. If you are struggling to pay your energy bill, you can now apply for Applying for THAW assistance is as easy as 1,2,3: YOU CAN NOW APPLY ONLINE: Create your own account Complete and save Track status Communicate with a THAW assistance Specialist 1. Review 2016 Program Guidelines to see if you meet eligibility requirements. (refer to the Document Checklist) be made directly to your energy provider. It may take up to 30 days for THAW assistance to be re-and the amount of your assistance payment. Submit an via THAW s website, mail, fax or email: Online: Mail: The Heat and Warmth Fund, 535 Griswold, Suite 200 Detroit, MI 48226 Fax: 1-888-618-1081 Email: (8429) to speak to a THAW energy assistance more at or by calling 1-800-866-THAW (8429)Thank you,Saunteel JenkinsThe Heat and Warmth FundDOWNLOAD MEAP1516by calling 1-800-866-8429$ @ $ @ $ @ $ $ Jul Aug Sep Oct Nov DecJan Feb Mar AprMay Jun0 0 0 0 $ :$690.

2 04$ Previous balance was due 05/30/13. Pleasepay thepast-due amount to avoid credit action. Thank applied after Jun 06, 2013 arenot included.$ $ $ $ $ $779 .95 Cash/Money Order OnlyJune29 Invoice205541370523 You r payment isdue July 01, 2013. After the due date,the unpaidbalance is subject to a 2% late paymentcha average residential customer is expected to save $ month over the life of the and Walmart are nowamongthe authorized merchants throughout Michiganthat accept payments on behalf of Consumers near you, visit andchoose "Payment Options." For your safety, DO NOT USEUNAUTHORIZED PAYMENT more than 100 ways to saveon your energy bill, Gas Safety and are committed to providing safe, reliable natural gas service whileprotecting the health and safety of our neighborswho live or work near our pipelines and safetytip s and learn what to do in an emergencyat :07/01/13 Enclosed:Total:$ use this checklist to make sure you are including all appropriate restored.

3 DOCUMENT CHECKLISTCopy of valid photo ID for the account holder, Driver s license or state issued ID: The address on the ID must match the service address on the account. If not, you must Copy of Social Security cards for all household members, including minors: or Other Fuel Vendor Invoice: The invoice will document the amount of fuel provided and Copy of 60 Days Proof of Income for ALL members of the household: annually (form included within this packet)Paycheck StubSocial Security StatementSSI StatementTANF StatementorororI Self income exceeding $8,500 must provide proofone of the followingpieces of documentation:DOWNOAD MEAP1516 THAW ENERGY ASSISTANCE2015-2016 ENERGY/GAS assistance PROGRAM GUIDELINESE ligibility: Total owing cannot exceed $2,000 for combined (gas and electric) accounts or $1,000 for single accounts (gas or electric) Account must be in the applicant s name.

4 If the account is not in the applicant s name he/she must accept responsibility for the bill with a valid ID or Driver s License - The person at the appointment MUST have all required documents need on their behalf - A signed from the account holder them permission to apply on their behalf Account must be (not a commercial account) Applicant must pay illegal or unauthorized usage charges and security fees Accounts MUST have a past due balance (usage arrearage) If services are not restored within 30 days of THAW commitment, funds will be removed from the -count. Clients must have service within 30 daysIncome: Proof of households income is required. A household is income eligible with an income of not more than 150% of the federal povertyguidelines. The following 2015 Federal Poverty Guidelines for monthly income will be in effect Family Size: 1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person Income $1, $1, $2, $3, $3, $4, $5, Please Note: Following services do not qualify as usage arrearage: - unauthorized or illegal usage - provider late fees - provider unregulated services (appliance repair) - bankruptcy - cooking gas Applicants eligible to receive THAW MEAP assistance if enrolled in DTE Energy s L S P, Consumer Energy s CARE and/or SEMCO Energy s MAP programacALLmembersmay not be1 I hereby make applicaon for the Michigan Energy assistance Program (MEAP).

5 I understand that there may be a delay in processing if there is missing informaon. The MEAP crisis season runs from November 1 through May 31 therefore emergency assistance may not be available June 1 through October 31. Michigan Energy assistance Program H ous eh ol d I nfor m at i on List everyone who lives in your home, including adults and children temporarily absent due to illness or employment. People are considered members of your household if they sleep and keep their Name Social Security Number Date of Birth Yes No Name Social Security Number Date of Birth Yes No Name Social Security Number Date of Birth Yes No Name Social Security Number Date of Birth Yes No Name Social Security Number Date of Birth Yes No H ous eh ol d A ddr es s ( Se r v ic e A ddr es s ) Address (Numbers & Street Name, Apt.)

6 , etc.) SELF City State County Zip Code Mai l i ng A ddr es s , i f dier ent t han abov e Address (Numbers & Street Name, Post Office Box) City State County Zip Code A ddi t i onal I nfor m at i on N eeded H om e Hea ti ng Cre di t (H H C) : Have you ap pl ie d for or rece ived the H H C (E nergy D ra ft) in the las t 6 m on ths ? Yes, month received_____ No Have you or do you currently receive benefits from Department of Health and Human Services (DHHS)? Yes No H ave you rece ived energ y a ss is ta nce fr om an ot her agenc y o r thro ugh a prov ide r-sp onsore d p rogr am s ince O ct ober 1? Yes, who was the provider(s):_____ No _____ How do you heat your home? Natural Gas Fuel Oil Propane Electric Heat Wood Coal Other_____ Emergency Need: Check the service(s) that you the emergency for 30 days.

7 H ouseh o ld Hea t ing $_____ I f th is i s a pre pa id ac cou nt , amo unt in ac coun t $_____ * If de l iver ab le fue l , pe rcen tage rem a in ing i n tan k_____% t of the fuel remaining in your tank Electricity (non-_____ If this is a prepaid account, amount in account $_____ Name Social Security Number Date of Birth Yes No 30 Number of pregnant individuals in the householdDo you own or rent your home?OWNRENTIs the applicant a veteran?DOWNLOAD MEAP1516Is the applicant disabled?Yes No Yes No 2 E l ec t r ic ( non -heat ) P r ovider I nfor m at i on Name and address of company/energy provider Service address Name on account Account number H a s y ou r e l ec tr ic i t y b e en t u r n ed o ? No H ave you rece ived a pa st due or shu t o no ti ce for you r e lec tr ic i ty?)

8 Yes, when is service scheduled to be turned off:_____ Yes, date service was turned off:_____ No H ous eh ol d H eat i ng P r ovider I nfor m at i on Name and address of company/energy provider Service address Name on account Account number Has your heat been turned o or have you run out of your only No H ave you rece ived a pa st due or shu t o no ti ce for you r he at or a re yo u at r is k of running ou t of yo ur house ho ld hea t ing fue l? service is scheduled to be shut off:_____ Yes, date heat was turned off or when fuel ran out:_____ No H ous eh ol d I nc om e Please check all sources of income that your household expects to receive in the next 30 days Does your household have any income? No Yes, Total monthly Income:$_____ Social Security Supplemental Security Income (SSI) Disability benefits Self-employment income Employment/earned income Unemployment Money from family/friends Veteran s Benefits/ Military Allotments Child Support _____ Tribal payments (Energy assistance /LIHEAP, tribal GA, casino/gambling profit sharing, land claims, etc.)

9 Rental income or a land contract, mortgage or other payment payable to a household member Person with income Type of income (if employed, name of employer) Gross Monthly Income (Amount before taxes and expenses) (Weekly, biweekly, monthly, etc.) Ha ve t he r e been a ny cha ng e s or do y ou e xpe ct a cha ng e in y our hous e -hold inc om e in t he ne xt 30 da y s ? No Yes, Please briefly explain below: DOWNLOAD MEAP15163 for each. I nc om e E xpens es $ Health Insurance Premium Amount $ Court ordered child support Amount A c tu a l ch i l d ca r e co s ts p ai d b y a n em p l o ye d h ou seh o ld m e m b er , n o t DHH S Amount $ U nus ua l e m p loy m e nt r e la t e d e xpe ns e s Amount $ Explain Expense Si g nat ur e Requi r em ent verify my eligibility for assistance .

10 Michigan Energy assistance Program (MEAP). I authorize my energy company to release by phone, fax, email or their computer web site all available UNDER PENALTIES OF PERJURY, I SWEAR OR AFFIRM THAT THIS APPLICATION HAS BEEN EXAMINED BY OR READ TO ME. IF I AM A THIRD PARTY Applying ON BEHALF OF ANOTHER PERSON, I SWEAR THAT THIS APPLICATION HAS BEEN EXAMINED BY OR READ TO THE APPLICANT. TO THE BEST OF MY KNOWLEDGE, THE FACTS ARE TRUE AND COMPLETE. Signature of applicant or head of household Date Signature of spouse Date Address (Numbers & Street Name, Apt., etc.) Date Current phone number R eques t for R ev i ew in 10 u or your of this form. guarantee payment of funds, even if preliminary approval is granted. I hereby release THAW Fund, its employees, officers, directors and its partnering DOWNLOAD MEAP1516 Applicant Name: _____ Address: _____ a.