Outreach Pre-Registration

(Please note this is not an application)                                                                                                                                                                                                                            
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Inquiry Information
Please complete this form at least two days prior to attending an outreach event. Event dates are posted monthly at www.uesfacts.org

Address and Contact Information

Household Members

Income Information



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.

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.

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.

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 inquiry does not guarantee approval for the UESF utility grant. 


Thank You - UESF

The following documents are required before a utility grant can be approved. If you do not have digital documents available at this time please bring paper documents to the UESF outreach event you plan on attending. (Documents are required for all household members over the age of 18.)

  1. Most recent Utility Bill or Termination (Credit Denial Letter) or Shut-Off Notice
  2. Proof of Income  (last 30 days)
  3. Drivers license or State ID of primary applicant
  4. Social Security Card of primary applicant

Personal Identification




Additional Household Members