Faulkner,Cleburne, and White LiHEAP Application & Supporting Document Submission

• Fields marked with an * are required

• Name*
  First Last
• Address*
  Street Address City ZIP / Postal Code
• County You Live In*
  faulknercleburnewhite
• Phone
• Your Document (Must be .pdf, .doc, .docs, .jpg, or .png)
  Drop files here or

  Accepted file types: pdf, doc, docx, jpg, png.