Program Requirements:

• Applicant must be a resident of Duval County. 
• Applicant must have received a utility disconnection notice.
• Applicant must provide proof of income for the past 30 days(if applicable).
• Applicant must provide Identification for all adults in the home. Acceptable identification includes state-issued license or ID card, social security card, and/or passport
• Applicant must not have received assistance from the organization within the last 60 days for the same assistance type..
• Applicant must meet all guidelines and provide proof of eligibility, including supporting documentation 

Once application and all supporting documents have been received, the request for assistance will be submitted for review. Applicant will receive notice of determination.

By signing below, I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void. I authorize designated staff at The First Coast Leadership Foundation to collect further information from my landlord or utility company if necessary, to validate, review, and investigate my claims. I furthermore agree that my email contact and name provided in this application be added to The First Coast Leadership Foundation's digital and physical mailing list in order to receive further communications regarding this matter and other general communications sent out by and for The First Coast leadership Foundation.