Help The Home

Help The Home

Thank you for applying for the Help the Home program. We are eager to support you during these difficult time. However, we need more information from you to see if you qualify for assistance.
Applicant Name

First NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please explain your hardship.
Have you received assistance through our program before?
If yes, please list the month and year you previously received assistance.

Number of Family Members in Household

Rows	Children	Adults	Seniors
Enter number

Annual Household Income (in USD)
Please attach a copy of your proof of income. Acceptable Items: Last 2 paystubs, W2, 1099, Award Letter

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Are you currently unemployed?
Would you like assistance with Atmos Energy?
Please attach a copy of your Atmos Energy bill.

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Would you like assistance with electric?
Please attach a copy of your electric bill.

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Would you like rental/mortgage assistance?
Please attach a copy of your lease/mortgage.

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Do you need emergency food assistance?
Do you currently receive SNAP benefits?
Please upload verification of your SNAP benefits

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Please confirm the following statements:
Signature
*APPLYING FOR ASSISTANCE DOES NOT GUARANTEE APPROVAL*

All applications will be processed in the order they are received. Please allow 4-6 weeks for processing.
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