2024 United Way of Brazoria County HelpLine Intake Form (Rent/Utility Assistance)
Applying does not guarantee financial assistance. (UWBC will ONLY assist with the current month’s rent or utilities – no PAST DUE or LATE FEE amounts will be paid). ALL CASES ARE REVIEWED BASED ON THE CLIENT’S CURRENT PROOF OF HARDSHIP A case manager will review your application within 3 business days.   

RELEASE OF CLIENT INFORMATION

I certify that the information provided on this application is true and correct to the best of my knowledge and belief.  If granted assistance and fraud is proven, I will repay any funds spent on my behalf.  I authorize utility companies, my landlord, and my employer to release information to United Way of Brazoria County for the purpose of certification under the United Way of Brazoria County HelpLine Program.  

This certification is being made with the full knowledge and understanding that this statement and all applicable documents deemed necessary to substantiate my eligibility is subject to full discloser and verification by authorized United Way of Brazoria County Case Managers.  

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I understand and agree to the statements above. *
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