Energy Assistance Program

Thank you for providing your contact details, they have been submitted.

If you would like to speed up the process, please answer the questions below. Alternatively we will ask you these questions over the phone when we contact you.

Energy Assistance Program (additional information)

* = required

When is the best time to contact you? (Control click to select multiple)

Where did you hear about the program?:

How many people live in your home?

Do you have dependents below 18 living in the home?

Yes

If answer above is ‘Yes’, how many?

What age are you?

What gender do you identify with?

Is a translator required?

If a translator is required, please specify

If ‘Other’ above, please specify

Do you have a Commonwealth Concession card?

Do any of the following apply to you? (tick all that apply)

In the past year, I’ve been unable to pay my electricity or gas bill on time because of a shortage of money

In the past year, I’ve been unable to pay my rent, mortage or other bills on time because of a shortage of money (including water bills, telephone, credit card, or others).

In the past year, I’ve accessed my superannuation to cover expenses

In the past year, one of the following have happened to me because of a shortage of money: Pawned or sold something, Went without meals, Was unable to heat or cool home, Asked friends / family for financial help, Asked for help from welfare / community agency

I have difficulty reading or understanding my energy bills

I receive a Commonwealth Home Support package

Other, please specify below (If prefer not to say please put that below)

Other reason I need assistance, please specify below

By submitting this form, you agree to BSL using your details to contact and assist you, and sharing it with our partners Uniting and the Australian Energy Foundation. The BSL privacy policy is available here, you can also contact Emma de Campo on 0410 520 118 with questions or concerns.