EnergyUnited Logo
Close Menu
             
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 until the six month date.
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. If you or a household member has a medical situation not pertaining to disability, please
         provide verification (doctor's statement, official medical records, etc.) of this medical
         condition with this application.
     5. If you are requesting assistance with items other than monthly bills, i.e. house repairs, car
         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 be
         returned.
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. If the 25th falls on a weekend or holiday, the application must be received by the last business day prior to the 25th.
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 be strong grounds to deny 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, 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. 
Location


REQUIRED
The information provided in the application to EnergyUnited Foundation is true and complete. The Foundation is authorized to contact doctors, employer, any agency that provides assistance, and others to verify the information provided. I understand any deliberate falsehoods or efforts to mislead the Foundation will be strong grounds to deny the requested assistance. I also understand that the information contained in this application may be shared with other agencies or groups providing assistance. 
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, Last 4 of SSN (if over age 18), Relationship to Applicant, and Employer / School




Assistance Requested




Household Income

































Monthly Expenses



































Attachments












Other




Tax Returns



REQUIRED
The information provided in the application to EnergyUnited Foundation is true and complete. The Foundation is authorized to contact doctors, employer, any agency that provides assistance, and others to verify the information provided. I understand any deliberate falsehoods or efforts to mislead the Foundation will be strong grounds to deny the requested assistance. I also understand that the information contained in this application may be shared with other agencies or groups providing assistance. 

back to top button