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Please Note:

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. 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, 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. 
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, bills, emergencies, and other humane needs. Grants ARE NOT awarded for school tuition and fees, medical bills or business related expenses.


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.

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

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.



Tax Returns

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 result in denial of the requested assistance. 
I understand I will be notified if my grant has been approved or denied. I understand if approved, I will be required to provide current invoices.

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