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Please Note:
APPLICANTS MAY SUBMIT ONLY ONE APPLICATION EVERY SIX MONTHS.

If you complete this form prior to six months from your last application, unfortunately, it will not be considered for a grant.
Documentation Needed
Before proceeding with this application, please be sure to have the following documents ready to upload. You will not be able to complete the application without these documents.

1. Verification of your most recent monthly income (for all in the household) and all current         household bills.
2. A copy of pages one and two of your most recent Federal and State tax returns. W-2 forms, pay stubs, or 1099’s will not be accepted in place of tax returns.
  - Federal and State tax returns are required for each person in the household who files
3. Proof of Social Security income or a statement of disability from your physician.
4. Please provide documentation to outline grave need based on major life event (examples: proof of major life event, fire accident report, unemployment document, etc.).
5. If you are requesting assistance with items other than monthly bills, i.e. house repairs, etc., please submit at least two detailed estimates with your application. Estimates must be from different vendors for the same item(s) or work with the same materials and labor stated separately on each estimate. Applications with only one estimate will not be considered.
Application Due Dates
All applications are due by the 25th of the month to be considered the third Tuesday of the following month. Any applications that are received after the 25th will be considered two months later. 

Note: Any additional documents provided after the application is submitted will not be reviewed. 
Notable Information
The information obtained in this application is solely for the purpose of determining qualification for a grant from the EnergyUnited Foundation, Inc. and will be kept in strictest confidence. The person signing this application warrants that the information provided is true and complete. EnergyUnited Foundation, Inc. is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein. Any deliberate falsehoods detected will result in the denial of the assistance application.

To receive assistance from the Foundation, you do not have to receive electric power from EnergyUnited, but you must reside within EnergyUnited’s electric service area.
Funding Criteria
The EnergyUnited Foundation, Inc. Board of Directors shall disburse funds donated by members of EnergyUnited on behalf of individuals and households who are suffering unusual and/or unexpected problems and are in grave need of assistance. Grants may be used to pay for items such as shelter, utility bills, emergencies, and other humane needs. Grants ARE NOT awarded for school tuition and fees, medical bills or business related expenses.

APPLICANTS MAY ONLY SUBMIT ONE APPLICATION EVERY SIX MONTHS.

Disbursements are limited to $5,000 within a 12 month period for individuals and $10,000 within a 12 month period for households.

To ensure confidentiality, decisions made by the EnergyUnited Foundation Board of Directors will NOT be discussed with anyone. Reasons for Board decisions will not be given to anyone, including the applicant, if the request is granted or denied. 

You will be notified if your grant is approved or denied. If approved, you will be asked to provide current invoices so your approved bill can be paid directly to the vendor.
Location


Applicant Information















Employer Information











Persons Living in the Home
List all family members that live in the home below.
Please List: Name, Age, Date of Birth, Relationship to Applicant, and Employer / School




Assistance Requested







Household Income

Please use numbers only for below fields, do not use $ or other characters.






























Monthly Expenses

Please use numbers only for below fields, do not use $ or other characters.














Attachments






Other


Tax Returns

REQUIRED
The information provided in the application to The EnergyUnited Foundation is true and complete. The Foundation is authorized to verify the information provided. I understand any deliberate falsehoods or efforts to mislead the Foundation will result in denial of the requested assistance. 

Note: Any additional documents provided after the application is submitted will not be reviewed. 
I understand I will be notified if my grant has been approved or denied. I understand if approved, I will be required to provide past due invoices.

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