Utility Payment Assistance

Notice May 8, 2025

This program is out of funds for the remainder of 2025. Funding for this program was cut in half from previous years, so the funding was used quickly. Call our office at 931-456-6654 and press Option 1 to get other local resources that may be available to you.

Eligibility
This program is intended to help households keep access to their utilities through an unexpected financial hardship. Currently, only the below hardships are eligible for funding:

Medical hardships during the last 6 months
Car repair over $200 during the last 6 months
Loss of spouse or other income earner during the last 6 months
Taking on legal guardianship of a minor or other person during the last 6 months
Unexpected loss of job during the last 3 months

Ineligible Use of Funds
This program cannot be used for hotel rooms, rental deposits, down payment assistance, set-up fees, medical payments, credit card/auto/other loan payments, inflation, or anything other than utilities.

You will be asked to provide documentation of the hardship that has taken place and hardship must have happened in the timeframe noted above. Hardships incurred prior to time frame cannot be funded at this time.

Failure to turn in requested documents means the application is incomplete and will not be considered for funding.

Name of Primary Applicant*

First NameLast Name

Please submit a clear, readable copy of the front of your current ID. Feel free to black out the driver's license # and birthdate. Make sure it is not blurry. *

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How many reside in your home?*

Ages of those residing in your home (including yourself)?*

Address (This should be the property the applicant resides in and should match the address on the lease, deed, and utility statements.) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Email Contact (This is how we will primarily communicate about your application status.)*

example@example.com

Phone Number*

Area CodePhone Number

Has your household received financial assistance from us in the most recent 18 months?*

YesNo

If your household has received financial assistance from us in the most recent 18 months, you are not eligible currently to receive financial assistance under this program.

If you are approved for assistance, you will receive a 5-minute questionnaire 3 months after help is given. Response to this questionnaire is required should you wish to remain eligible for any future assistance from our agency. We will send this questionnaire via email.*

I/We understand

What type of utility assistance are you applying for? (You can check 1 or more but you will need to turn in most recent bills from each one you select.)*

Electric PaymentWater PaymentGas Payment

Please upload a clear, readable photo or PDF copy of each bill(s) you are requesting help with. Be sure to submit the most recent utility billing statement that shows utility company name and their address, your name, your property address, account number, and amount due.*

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Which eligible hardship are you applying under and submitting documentation for? (Check 1)*

Medical Hardship in the last 6 monthsCar repair over $200 in the last 6 monthsLoss of spouse or other income earner in the last 6 monthsTaking on legal guardianship of a minor or other person in the last 6 monthsUnexpected job loss in the last 3 months

Please submit a clear, readable document that proves the hardship checked above. If you are unable to provide documentation, the application is considered incomplete. Please feel free to black out sensitive information such as social security #s, driver's license #s, birthdates, type of procedure, description of disability, etc. We simply need to be able to see a financial hardship has occurred and can be attributed to your identity. Examples of acceptable documentation can be found at https://ccihomes.org/examplesRUPA *

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How will this help from our agency improve your current financial circumstance?*

How much financial assistance are you requesting total?*

$1 - $250$251 - $500$501 - $750

When you submit this application, you may be asked to provide Supporting Documentation. Are you willing and able to do this? (Please do not submit this application unless the answer is "Yes".)*

YesNo (please do not submit your application unless your answer is Yes.)

Utility Payment Assistance

Contact Information

Financial Assistance