Utility Assistance Application

Thank you for providing us the opportunity to assist you. We will review all requests, and you will receive an email when a decision is made. This normally takes 7 to 10 days. Please be aware it could take longer due to unforeseen circumstances.

Utility Assistance Guidelines/Requirements:

  • You must provide your home address AND an account number.
  • You must explain why there is a need for assistance. (Must be medical or benevolent.)
  • You must inform us of how much the total bill is and the due date.
  • We do not assist with new service, collection/reconnect fees, payment to old/disconnected accounts.
  • We do not pay bills in full or in “advance”.
  • An individual may only apply for utility assistance once per year.

If all information requested is not provided, we will be unable to process your request.

Although each case is different, we do not pay more than $75 towards a utility bill.   The need for assistance will be verified with the Utility Department and/or other source/organization involved.

Please note that we are unable to make checks payable to or mail to an individual. Please be sure to list the name and address of the utility company that will be able to accept the donation on your/their behalf.
By checking the box below, you agree you have read and accept the guidelines/requirements for receiving assistance.(Required)

Utility Assistance Application Form

Name(Required)







Address(Required)


















Employed?(Required)


Marial Status(Required)




If married, is spouse employed?


Head of Household?(Required)


Address of Utility Company(Required)















Due Date(Required)



Is any of this amount past due?(Required)


Have you been assisted by The Long-Lewis Foundation in the past?(Required)


Date of last assistance from this Foundation:



Have you received assistance from another organization/church in the past?(Required)


Date of last assistance from any other church/organization: