Ferndale Community Utility Fund Application
This application is for assistance with a Ferndale City Utility bill. Please complete the application completely. Please also gather electronic copies (a picture is ok) of the required documents: a copy of your water bill, and proof of income for all adults in the household. You will receive a follow up call or email from one of our intake volunteers. If you can't get any of the listed documents, please let us know. *All of the information you provide us with will remain confidential. Please note: This program is funded by community donations and we can't guarantee assistance will be provided. We will reach out to you on a first come-first served basis. If many people request assistance, it may take us a while to get back to you. Please be patient! We will do our best to serve as many people as we can.

**Please email copies of your proof of income, and your utility bill to FCUfund@gmail.com.
Please tell us your first and last name. *
Please tell us your phone number. *
What is your email address? *
What is your preferred method of communication? *
If we call you, may we leave a detailed voicemail? *
What is your address (please include number, street, apt number, city, state, and zip *
What is your City of Ferndale Utility account number? *
What is your total amount due? *
How much of this bill can you cover? *
Is the bill in your name? (Please write yes or no. If no, please also write the name and phone number of the bill holder.
If the bill is not in your name, do we have your permission to contact the bill holder?
Clear selection
How many adults live in your household? *
How many children live in your household? *
How has your household been impacted by COVID-19 *
Please tell us about the sources of income in your household. Choose all that apply *
Required
Please tell us the total monthly income from all those sources, for every adult in your household. (Total household income) *
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