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Utility Assistance Program Application

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Please correct the field(s) marked in red below:

To enroll, complete this application form and include the following:

  • A scanned copy/photo of your Southern California Electric bill or Southern California Gas bill showing that you are enrolled in their CARE program
  • A scanned copy/photo of your City of Thousand Oaks utility bill
Customer Information
Customer Information


I hereby authorize City of Thousand Oaks to enroll me in the Utility Assistance Program.

I agree to inform the City of Thousand Oaks if I become ineligible for the program.

I agree to furnish proof of eligibility when requested.

I understand that if I receive the credit without qualifying for it, I may be required to pay back the credits I received.

By typing my name below, I acknowledge this agreement.


Upload required documents here:

Upload required documents here:
  1. To receive a copy of your submission, please fill out your email address below and submit.