• Utility Assistance Application Client Intake Form

    Funding is provided by United Way of Gaston County, Community Foundation, Energy United Foundation and various donors. This is only an application and does not guarantee assistance. Please provide as much information as possible. The amount of funding is based on different factors and types of funding available.

  • Unfortunately, you are not in our service area. The Dallas High Shoals Christian Ministry is a crisis agency that serves the residents of Gaston County with a financial focus on Dallas, High Shoals, Stanley, and Alexis. 

    If you feel you have reached this page in error, please try again or contact us at dallasministry@gmail.com

  • Client Information

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Format: (000) 000-0000.

  • Household and Financial Information

  • Please answer for EVERY person living in the home INCLUDING yourself and children. (To add information for another person, click add person)*
  • Please answer yes or no for each field
    Rows
  • Which best describes your living status?*
  • Do you receive assistance with housing through HUD or section 8?*
  • Does it state in your lease that you must maintain utility service to avoid eviction?*
  • Would you be interested in information on creating a simple budget?

  • Utility Service Information

  • Please fill out all fields
  • Due date of bill
     - -
    2 digit month, 2 digit day, 4 digit year
  • Cut off date if listed
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Additional Information

  • Should be Empty: