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.*
YesNo
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*

Cancelof
YesNo
YesNo
Please attach a copy of your Atmos Energy bill.

Cancelof
YesNo
Please attach a copy of your electric bill.

Cancelof
YesNo
Please attach a copy of your lease/mortgage.

Cancelof
YesNo
YesNo
Please upload verification of your SNAP benefits

Cancelof
I certify that all information provided is true and accurate.I understand that submission of this application does not guarantee assistance.I authorize verification of the information provided.
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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