Utility Payment Assistance

Office Closed for Christmas: No applications will be processed after Wednesday, December 18, 2024, for the remainder of the calendar year. You can expect a staffmember to follow up with you regarding your online application by 4PM on Wednesday, January 8, 2025.
Utility Payment Assistance

This program is intended to prevent loss of utilities only for those living in Cumberland County of Tennessee. Because this is a totally community-funded program, funds are limited. This application is also available via paper.
EFFECTIVE IMMEDIATELY DECEMBER 18, 2024!

We will no longer be assisting with rent and/or mortgage payments as of 12/18/2024. This is for our staff's protection due to repeated instances of harassment by various individuals, landlords, and mortgage companies. We look forward to helping applicants stay up to date on their utility bills like electric, water, and natural gas.
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.
Contact Information

This should be the primary person on the rental, mortgage and/or utility bills and who also lives at the residence needing assistance.
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
Financial Assistance

This is where you will describe what type of financial assistance you are requesting.
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.)
Should be Empty:

Utility Payment Assistance

Contact Information

Financial Assistance