Rental & Utility Assistance for Cumberland County Residents
This application will let you instantly apply for payment assistance on monthly rental and utility bills that circumstances caused you to fall behind on during this year.
Contact Information
This should be the person(s) on the rental and utility agreements and who also lives at the residence needing assistance.
Name - Primary
*
First Name
Last Name
Name - Secondary
First Name
Last Name
How many reside in your home?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Contact
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Financial Assistance
This is where you will describe what type of financial assistance you are requesting. If you need Rental PLUS Utility assistance, please note this in your Request Description.
What type of assistance you are requesting?
*
Rental Payment Assistance
Utility (gas, water, electric) Payment Assistance
In the last 12 months, did you miss more than 2 payments on the rent/utility you are requesting assistance on now?
*
Yes
No
Not sure
Are your payments on that particular account currently deferred, in forbearance, in arrears, on extension, or otherwise "due at a later time" because of COVID-19?
*
Yes
No
Not sure
What caused you to fall behind on your payments?
*
Job loss
Reduced hours
Depleted savings
Request Description. Please describe your request for financial assistance in your own words (which type of assistance you are applying for, when it began, what happened, etc.):
*
How much financial assistance are you requesting total?
$1 - $500
$501 - $1,000
$1,001 - $1,500
$1,501 - $2,000
Over $2,000
When you submit this application, you will be asked to provide Supporting Documentation for statements made in this application. Are you willing & able to do this?
Yes
No (please do not submit your application unless your answer is Yes.)
Submit
Should be Empty: