United Christian Ministries: Financial Assistance Request Form

OUR SERVICE AREA INCLUDES PICKENS COUNTY (EXCEPT CENTRAL AND CLEMSON) AND THE POWDERSVILLE AREA. If you are seeking food assistance, you do NOT need to fill out this form.We have a drive-thru food pantry available on Mondays, Wednesdays and Fridays between 9am-noon.

Email address *

You will receive an email from UCM Reception (ucmpc2018@gmail.com). Please check your trash/junk/spam if you don't see an email within two days. We will NOT contact you by phone until we have received all the required documents.

Please note that your online request can take up to a week to process. If you are in danger of disconnect or eviction this week, we advise you to come to our office on Monday, Wednesday or Friday from 9:00-10:30am with the required documents (see below).

What is your FIRST name as it appears on your ID? *

What is your LAST name as it appears on your ID? *

Please provide a phone number where you can be reached between 9am-noon. (We will not call you until you email us the required documents.) *

What city do you live in? Please note that our service area includes Pickens County (except Central and Clemson) and the Powdersville area of northern Anderson County in South Carolina. *

Have you received food or financial assistance from United Christian Ministries before? *

Yes

I'm not sure or I don't remember

Required

How can we help you? What kind of financial assistance are you requesting help with today? *

Utility bill assistance (electric/water/sewer)

Utility deposit

Rent assistance

Rent deposit

Heating assistance/fuel

Other

Required

Please check the boxes that correspond to your situation. (If your household income has been affected by COVID-19, we will require documented proof such as your DEW username & password, paycheck stubs, and/or a letter from your employer.) *

COVID-19 has NOT affected my household employment status or income

reduction in hours due to COVID

laid off (employment with company is over) due to COVID

furloughed (unpaid leave of absence, but will be returning) due to COVID

personal decision to temporarily leave or reduce hours due to the risk of exposure to the virus.

company/employer has shut down until further notice due to COVID

Required

We often need to contact other agencies in order to determine the approval or denial of your request for financial assistance. This may include your utility company, landlord, employer or other local agencies that you have recently received financial assistance from. (Check only ONE box.) *

I hearby authorize United Christian Ministries (UCM) to request and/or release any and all information concerning my employment, financial affairs, applications for assistance, family & personal relationships, and such other information as may be needed to determine the approval or denial of my request to UCM for assistance. Furthermore, I certify that the information given to a UCM representative to be true. I understand that if such information is found to be false, I forfeit the right to receive assistance from UCM both now and in the future.

I do not authorize United Christian Ministries to request and/or release my information in order to determine the approval or denial of my request for assistance. I understand that I may not be able to receive financial assistance from UCM without this approval.

Required

When we receive the required documents by email, a UCM representative will call you on Monday, Wednesday or Friday between 9:00-11:30am for an intake interview about your situation. Below are the topics that will be discussed. Please check EACH box after you have read the descriptions so that you will be prepared. *

HOUSEHOLD PROFILE (names of everyone in the home, their dates of birth, genders, relationships to you, education levels)

MONTHLY INCOME (employer name or type of income for everyone in the home, $ per hour and hours per week working, gross monthly income, SNAP benefit amount)

MONTHLY EXPENSE AMOUNTS (rent or mortgage, phone, electricity, water, heat, transportation, medical, loans, credit cards, child care, tobacco, Internet, cable, etc.)

Required

Before we will contact you about your situation, we will need the following documents emailed to ucmpc2018@gmail.com. Please check ALL the boxes after you have read each requirement. *

ID (If your ID does not include your current address, we will need proof of residency.)

Social Security cards for everyone in the home (If we already have them on file, you do not need to resubmit them.)

Proof of earned income for everyone in the home for the last 30 days (pay check stubs, 2019 tax return, etc.)

Proof of unearned income for everyone in the home for the last 30 days (2020 Award Letter, unemployment benefit letter, current monthly bank statement showing deposit, etc)

An eviction or late notice if seeking rental assistance

A copy of your current utility bill if seeking utility assistance

Required

Send me a copy of my responses.

Submit

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms