(PREVIOUS) Request for Financial Assistance

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Catholic Center of Concern in Huntsville Utility Assistance Application

This application is for households seeking assistance with utility expenses. Please complete all sections of the form and upload the required verifiable documentation to ensure timely processing.
Important Information: PLEASE DO NOT SKIP THIS STEP
• Assistance is based on eligibility, available funding, and program guidelines
• Submitting an application does not guarantee assistance
• Incomplete applications cannot be processed
• Applicants will not be contacted for additional or missing information.

Please have the following verifiable documents ready before beginning:
• Valid photo identification and social security cards of all household members
• A copy of your monthly household income (please include all)
• Most recent utility bill
• Proof of all household income
•Copy of lease or mortgage statement
• Any other supporting documentation relevant to your request

Please follow the application directions, and please do not skip any steps.

Once your application is reviewed, you will be notified of the status. An incomplete application will be denied immediately.
Contact Information
Name

FirstLast name
SSN
last 4 digits
Email
example@example.com
Address

Street

Street Line 2

CityState/Province

Postal codel
Phone Number

Area codeTelephone number

List of all household members, including yourself

If you have additional household members beyond the above offered 6 slots enter them here.
Please know that this application is for utilities assistance only. No other assistance will be granted. (Please check the box)*

Utilities

Utilities Account

	Account Number	Amount Due	Due Date
Utilities Account

Employment Income

Other types of Income

Monthly Expenses

Please attach an image of all ID's of ALL HOUSEHOLD MEMBERS 18 AND OLDER.*

Attach Image
You must attach your drivers license to this application. Cancelof
Please attach an image of ALL household members social security cards .*

Attach Image
You must attach your social security card to this application. Cancelof
Please attach your most recent paystubs or any other income received by anyone older than 18 in your household (need the last 6 paystubs uploaded)*

Attach Image
You must attach your paystubs to this application. Cancelof
Please attach lease (need first page with tenants and monthly cost as well as the signature page) .*

Attach Image
You must attach your social security card to this application. Cancelof
Please attach your most recent utility bill here.*

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You must attach your utility bill to this application. Cancelof
Should be Empty:

Catholic Center of Concern in Huntsville Utility Assistance Application