Complete the information below only if you have no other way to document your income. Please complete all applicable sections. If not all sections are complete there may be a delay in processing your application.
If you are receiving help paying your bills and / or expenses from a non-household member, please list their name(s) and phone number(s) below, including a signed statement from that person(s). The statement should note how much money is provided, how often, and if the money is given to you or paid directly to your creditors. If more than one person is paying expenses, have him/her submit a separate signed statement as well and provide their name(s), phone number(s) and address(es) below.
How is car payment / insurance paid?
How is cable/internet bill paid?
How are personal expenses paid?
How are bulk fuels paid for?
How are other expenses paid?
Rental Assistance (i.e. Section 8, HUD, Metropolitan Housing)
Is Utility allowance paid directly to the utility companies?