United Way of Greater Stark County Village of Brewster Utilities Fund
United Way of Greater Stark County is seeking to help those living in the Village of Brewster with a one time utilities assistance due to a job loss and/or reduction of hours by the COVID-19 pandemic, as of March 14, 2020. Support will be given to those meeting the eligibility requirements and until funding is exhausted.

A household may qualify for service ONE TIME in a 12-month time frame.

To qualify for the assistance the following criteria must be met. Please have these items available when an Impact Team member contacts you.
1. Must have proof of temporary layoff or job loss as a result of COVID 19 (one of the following 3 work for verification
- A letter from the Ohio Bureau of Unemployment
- A letter, on letterhead from your employer and last paystub – It must have a supervisor or managers name and contact phone number
- A copy of Ohio Department of Job and Family Services Mass Layoff Instruction Sheet (form JFS 00671 rev 3/2020) received from your employer and you must include a supervisor or managers name and contact phone number
2. Must reside within the Greater Stark County area
3. Must have valid photo ID
4. Must have a valid phone number and an email address
5. Must be at or below the 200% Federal Poverty Line

**Additional documents will be requested depending on the assistance being requested and the Impact Team member will provide further information when they contact you.

Pictures and/or scans of the items listed above will be requested to be sent via email once approved.

Please answer the below eligibility questions, as well as confirming the releases of information that allows the Impact Team to verify your information with your employer and service providers.

A Impact Team member will review your information and will notify you of your status within 48 business hours.
Email address *
Do you reside in the City of Brewster? Note this fund is only available for those residing in City of Brewster. *
First Name *
Last Name *
Birthday *
MM
/
DD
/
YYYY
Last 4 SSN *
Home Address *
Home City & Zip Code *
Phone Number *
Were you recently laid off and/or experienced a reduction of hours due to the COVID-19 pandemic? *
What is your monthly income? (include benefits, unemployment, wages, child support)
How many ADULTS are in the home?
How many CHILDREN are in the home?
Name of Previous Employer *
Date of Layoff and/or Reduction of Hours *
MM
/
DD
/
YYYY
Previous Employer Contact Name *
Previous Employer Phone Number *
By checking I Accept, you agree to allow the United Way Impact Team to call your previous employer to verify layoff and/or reduction of hours. Verification is needed to receive assistance. *
What is the current utilities balance amount?
Provide Name
Provider Phone Number
By checking I Accept, you agree to allow the United Way Impact Team to call your Utilities Company to provide payment information. Verification is needed to receive assistance.
Clear selection
By entering your full name (First, Middle Initial, Last) below, you are agreeing to sign this form electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement.
Thank you for reaching out to United Way of Greater Stark County. We are in receipt of your inquiry for assistance with your rent or mortgage. One of our Impact Team members will contact you within the next 3-6 business days.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy