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Application for Free Utilities Relief Program 2020-2021

Eligibility Criteria

This application will help My New House pre-determine if you and your family qualify to receive one-year free utility expenses.

Who can apply:
 
  • Single mothers or single fathers who have children younger than 18 years of age, and who attend school in Los Angeles.
  • Single mothers or single fathers who have children of any age, and who have a disability.
  • Single mothers or single fathers who are the only economic support for the household.
  • Single parent households who reside in Los Angeles.
  • Grandparents, aunts, or other relatives who are the head of households, who are the legal guardians, and meet the above criteria.
  • Applicant without a social security number, a permanent resident card, or a citizenship certificate.

Who does not qualify:

  • Single mothers or single fathers who do not pay utility bills, who do not have a child younger than 18, who do not have a child with a disability, whose children live outside the country, and who live with a significant other.

 The process is divided into three phases:

1) The application (August 2019)
2) The interview (February – April 2019)
3) Proof of income and eligibility (April – May 2019)

In the event, My New House considers you a candidate for this program; you will receive a letter via email at each phase.


APPLICATION

Guidelines:

  • Not following our guidelines may affect your eligibility.
  • Do not leave blank answers; especially the last question, why do you think My New House should consider you and your family to receive free services?
  • Multiple applications from the same person will disqualify you.
  • Do not contact My New House to inquire about your eligibility.
  • At this time, we are only collecting information from the applicant and families. You do not need to provide proof of any documentation.
  •  Applications after August 10th will not be accepted.
  • You will read the word “survey” many times. Please continue completing the application. This word does not alter the information requested.
1.Legal Information:(Required.)
2.What is your gender(Required.)
3.What is your date of birth? (Enter date in mm/dd/yyyy format.):(Required.)
4.What is your race or ethnicity?(Required.)
5.What languages do you speak fluently? Do not mark the ones you just understand(Required.)
6.Choose the option that best describes your immigration status in the United States:(Required.)
7.What is your current marital status?(Required.)
8.Are you the head of household in which you live? Meaning you are the whole responsible for the care and all the expenses of the family(Required.)
9.Are all the utility bills and contracts under your name? What is his/her relationship to you?
10.List all the people who live in your household, age and their relationship to you. Do not add all those who are temporarily living in your house or live outside the country.
Age
Enrolled in (K-12) School
Disabled
Relationship to you
Self
Other 1
Other 2
Other 3
Other 4
11.Choose the option that best describes where you live:
12.What do you currently do for living? (Check all that apply)
13.Where do you work?
14.What is the highest grade or level of education you have completed?
15.Where do you go to school?
16.Do you or any of the family members...(check all that apply)
17.Do you own? (Check all that apply.)
18.What is your current bank balance (savings and checking combined)?
19.Do you or any of your family or household members suffer from an injury or illness that prevents you from working?
20.Have you ever filed for sexual harassment at any of your jobs?
21.Do you or any members of your family or household have any of the following conditions? (Check all that apply.)
22.Are you a victim of any of the following? (Check all that apply.)
23.Does your condition prevent you from doing any of the following?
24.Have you ever had to leave your home because of a disaster or lack of payment?
25.Have you or anyone in your house ever been incarcerated?
26.Have you had any deaths in the family in the past five years? List all deaths.
27.Why do you think My New House should consider you and your family to receive free services?(Required.)
Confidentiality


The information that we collect from this application will be kept confidential and will not be available outside of the Utilities Relief Program of My New House.

Please do not contact us to ask for your benefits. My New House will be contacting you as information becomes available. These four phases may take up to a year. If any of your information changes, please contact us at FreeUtilities@MyNewHouseLA.org. We also suggest you follow us on Facebook or Instagram at MyNewHouse777. We use social media to update our followers of any latest programs.
28.I hereby acknowledge that I have read and understood the terms and conditions as provided in this application.(Required.)
Current Progress,
0 of 28 answered