Client Utility Grant Inquiry Form

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Inquiry Information



MM/DD/YYYY













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.




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 or  have not recieved a MEAF grant within the past 12 months. 

·         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

Please upload all required documents outlined on page one and below before submitting.

Acceptable forms of documentation include: PDFs, scanned documents, photos, or screenshots. File names cannot contain special characters. Inquiries missing documentation will not be processed.


-Proof of gross income from the past 30 days for all household members over 18 years of age.


-Copy of your state issued photo ID or passport (include copies for household members over 18 years of age).


-Copy of your social security card (include copies for household members over 18 years of age).


-COMPASS benefits statement for the entire household (if received).


-Copy of your most recent utility bill(s) or shut-off notice.

Personal Identification


Income

Utilities

UAP Documents

COMPASS


Additional Household Members