Eagle Mountain City Utility Assistance Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City Account Number
*
Do you own AND live in the property for which you are applying?
*
Yes
No
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How many people live in your household?
*
1 person
2 people
3 people
4 people
5 people
6 people
7 people
8+ people
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Please select your household annual income (1 person)
Less than $22,900
More than $22,900
Please select your household annual income (2 people)
Less than $43,600
More than $43,600
Please select your household annual income (3 people)
Less than $49,050
More than $49,050
Please select your household annual income (4 people)
Less than $54,500
More than $54,500
Please select your household annual income (5 people)
Less than $58,900
More than $58,900
Please select your household annual income (6 people)
Less than $63,250
More than $63,250
Please select your household annual income (7 people)
Less than $67,550
More than $67,550
Please select your household annual income (8+ people)
Less than $86,340
More than $86,340
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Hello! Thank you for your interest in Eagle Mountain City's Utility Assistance Program. Unfortunately, you are ineligible for this service at this time. Please feel free to apply again in the future.
Eagle Mountain City receives federal money for this program and as such, we are bound by the federal government's eligibility standards.
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Please select your race/ethnicity: (select all that apply)
*
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Please upload a copy of your MOST Recent paystub or tax form for ALL employed members of your household. This is REQUIRED for application consideration.
*
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Denial Reason
Please Select
Over Federal Income guidelines
Income docs not provided or not valid
Name on app doesn't match utility account
Renter
This Page is for Eagle Mountain City Office Use Only
Application Status
Approved
Denied
Reviewed By (Name or Intitals
Reviewed Date
-
Month
-
Day
Year
Date Picker Icon
Payment Due Date
-
Month
-
Day
Year
Date
Credit Amount
Should be Empty: