Client Utility Grant Application

Applicant Information












Address and Contact Information







Household Members


















































Income Information

$

LIHEAP/Crisis



Please add a $ in front of the amount.



Please add a $ in front of the amount.
PECO Information


If No- Please Provide Documentation
If address on PECO bill is not the same as home address, or if name on PECO bill does not match client's name, please provide documentation.



Please add a $ in front of the amount.

PGW Information


If address on PGW bill is not the same as home address, or if applicant name is not the same as name on PGW bill, please provide documentation.



Please add a $ in front of the amount.

PWD Information


If NO- client is not eligible for servcies

If NO- Client is not eligible for services.
If address on Water bill is not the same as home address, or if name on Water bill does not match client's name, client is not eligible for services.



Please add a $ in front of the amount.

Required Documents

I, the applicant, do hereby certify that I have not, nor has any member of my household

 applied for a Utility grant through UESF’s Utility Grant Program within the past two years.

·         I, the applicant, give UESF authorization to request information from and/or speak with any representatives from my utility companies (if receiving utility assistance), with my landlord, property management company, or mortgage lender (if receiving housing assistance), and/or with any of my social service providers or medical professionals if input from these parties is necessary for the processing of my application for assistance.

·         I understand that the information supplied in this application will be reviewed by individuals involved in the approval of financial assistance at UESF.

·         I understand that UESF can release information on my application for the purpose of reporting to key funders and stakeholders who support the provision of utility and housing assistance to low income families.

·         By pressing submit, I acknowledge and permit representatives of UESF to verify all information. Any intentional misrepresentation of information contained in this application will result in forfeiting my grant application(s) now and in the future.

 

Submitting this application does not guarantee approval for the UESF utility grant. 

 

Thank You - UESF

Thank you for applying for a utility grant from UESF.  


Please take a picture of the following items (these are required):

  1. Most recent Utility Bill OR Termination (Credit Denial Letter) Bill OR Shut Off Notice
  2. Proof of Income
  3. Divers license of primary applicant