Energy Smart Eastside Boost Application Form

The Boost program covers 100% of the costs related to switching from gas, oil, wood or propane heat to an efficient electric heat pump. Total household income must be at or below 80% of Area Median Income. Refer to the Boost Program Guidelines to determine eligibility.

For alternate formats, interpreters, or reasonable accommodation requests, please phone 425-452-5362 (voice) or email EnergySmartEastside@bellevuewa.gov. Please specify your city of residence to assist in making accommodations. For complaints regarding modifications, contact City of Bellevue ADA/Title VI Administrator at 425-452-6168 (voice) or email ADATitleVI@bellevuewa.gov. If you are deaf or hard of hearing, dial 711.

Primary Applicant Information

First Name*

Last Name*

Phone Number*

Email*

Street address*

Postal code*

Eastside City*

State of Residence

Co-Applicant Information

First Name, Last Name

Mobile phone number

Email Address

Household Information

Primary Current Home Heating:*

Does your home have air conditioning?

Yes

Home Type:*

Home Square Footage

Number of people living in the household*

Estimated Annual Income of all adults in the Houeshold:*

Is anyone in the household over the age 65?

Yes

Languages spoken at home:

Please select all that apply to applicant:

Female

Male

Prefer not say

Other: Please Specify

I agree to terms & conditions.*