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2. The Lifeline Assistance Program (LAP) provides eligible low-income customers with assistance on their water utility bill by providing up to nine (9) units of water per billing cycle at no cost.
4. Eligibility Requirements
   Only residential customers are eligible to participate in the District's LAP. To apply, customers must submit a LAP application (in person, by mail or online) along with demonstration of financial need. To demonstrate financial need, please submit a current copy of your Southern California Edison or Southern California Gas Company utility statement showing participation in California Alternative Rates for Energy (CARE) or Family Electric Rate Assistance (FERA) programs. If approved, LAP funding will be applied to the customer's next water bill following application approval. The customer applying for LAP must be named on the District water bill and also match the customer named on the Southern California Edison or Southern California Gas Company utility statement. Customers participating in LAP are required to renew each year and may be asked to recertify their eligibility sooner. Program participants must notify the District within 30 days if they no longer meet eligibility requirements
6. Limited Funding Available
   Customer participation in LAP is on a “first come, first serve” basis. Program funding is limited and not guaranteed.
7. Income Qualifications
   CPUC's CARE Program Income Guidelines

   Income guidelines are set each year by the California Public Utility Commission's CARE Program.
9. First Name*
10. Last Name*
11. MVWD Account Number*
13. Phone Number*
14. Email*
16. Service Address*
18. City*
19. State*
20. Zip Code*
22. Gas or Electric Utility Statement*
    Please submit a current copy of your gas or electric utility statement showing participation in CARE or FERA programs.
23. Second Page of Utility Statement
24. Additional Attachments
26. I affirm, under penalty of perjury, that I am the above account holder and the information contained herein, including supporting documentation, is complete and accurate. I further understand that all applications are subject to review and I may be liable for back charges if I provide incorrect information.
28. Electronic Signature*
29. Date*
    Date
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31. 1. Receive an email copy of this form.
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