Ferndale Community Utility Fund Application
Thank you for applying to the Ferndale Community Utilities Fund!  Please read the following so that you are completely aware of the program requirements:
- This program is ONLY for City of Ferndale water/sewer customers.
- Please fill-out the application COMPLETLY, providing an answer for each question.
- Please tell us your COF utility account number carefully- including any decimal points.
- When you have completed the application, please email a copy (a picture is ok) of your current water bill AND proof of income for all adults in the home to fcufund@gmail.com.
- You will receive a follow up call or email from one of our intake volunteers.  If you can't get any of the listed documents, please let us know.  *All of the information you provide us with will remain confidential.

Please note:  This program is funded by grants and donations and we can't guarantee assistance will be provided.  We will reach out to you on a first come-first served basis.  If many people request assistance, it may take us a while to get back to you. Please be patient!  We will do our best to serve as many people as we can.

**Please email copies of your proof of income, and your utility bill to FCUfund@gmail.com.
Sign in to Google to save your progress. Learn more
Please tell us your first and last name. *
Please tell us your phone number. *
What is your email address? *
What is your preferred method of communication? *
If we call you, may we leave a detailed voicemail? *
What is your address (please include number, street, apt number, city, state, and zip *
What is your City of Ferndale Utility account number? (Please include decimal points) *
What is your total amount due? *
Do you owe a balance from past billing cycles? Please type yes or no.  (If yes, we will refer you to the Opportunity Council's water assistance program FIRST, and then our program will kick in second. We will contact you with information about the program.) *
Is the bill in your name? (Please write yes or no.  If no, please also write the name and phone number of the bill holder.
If the bill is not in your name, do we have your permission to contact the bill holder?
Clear selection
How many adults live in your household? *
How many children live in your household? *
Please tell us about the sources of income in your household.  Choose all that apply *
Required
Please tell us the total monthly income from all those sources, for every adult in your household. (Total household income) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms