Emergency Fund Application

Please complete the following application online. Once submitted, a member of Eastern 8 will reach out to you. If you have any immediate questions, please call us at 423.232.5097. Thank you!

**Currently Limited to Eastern Homeowners and Tenants**

Name(Required)

First Last

Email Address(Required)

Cell Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of People in your Household:(Required)

Monthly Income in your Household:

Proof of Residency Documents (Utility Bills, Lease Agreements, etc.):

Max. file size: 500 MB.

Proof of Income Documents (Pay Stubs, Tax Returns, etc.): *

Max. file size: 500 MB.

Are you Receiving any Government or Financial Assistance? If so, from who and how much?(Required)

What Type of Utility/Emergency Assistance are you Requesting?(Required)

What is the Amount of Financial help you are Requesting?(Required)

What is your Utility Account Number or Provider Details?(Required)

Is there anything else we should know / you would like us to be aware of regarding your situation?

Signature(Required)

Phone

This field is for validation purposes and should be left unchanged.

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