Project Deserve Application PDF Details

The Project DESERVE Application form is an essential tool for Westar Energy customers in need of financial assistance with their utility bills. Designed to support individuals based on their financial necessity, the program accepts applications through various channels including mail, fax, and email, as well as offers online registration options. Eligibility hinges on certain criteria, such as age, disability, or meeting specific income guidelines, ensuring assistance reaches those who need it most, with benefits up to $200 towards the account balance at the time of review. Applicants are required to provide comprehensive household information, including details of all income sources and monthly expenditures, alongside the necessary verification documents to substantiate their application. The form meticulously outlines what constitutes as valid income verification and emphasizes the importance of submitting copies rather than original documents, all of which will be securely destroyed post-review. Furthermore, it sets clear expectations regarding the submission process, required documentation, and the timeframe within which applicants can expect to receive a decision, underlying the program's commitment to transparency and assistance for individuals facing financial challenges.

QuestionAnswer
Form NameProject Deserve Application
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesproject deserve application, project deserve topeka, center of hope, project deserve application wichita ks

Form Preview Example

Project DESERVE Application

This program provides assistance to current Westar Energy customers with active service in their name. Applications may be submitted by mail to Center of Hope Inc., P.O. Box 3237, Wichita, KS 67201; by fax (316) 267-7778; or by email ProjectDeserve@centerofhopeinc.org. Online registration is available at centerofhopeinc.org. Please see page 3 for other important information and requirements. Assistance is determined on the basis of need, subject to the availability of funds.

To be eligible for this program, a member of your household must meet one of the following categories:

65 Years or Older or receives

OR

permanent disability income from

 

SSI or SSD

 

If approved, you will be assisted with the amount due on your account at the time of review, up to $200.

Meets the income guidelines below

If approved, you will be assisted with the amount due on your bill at time of review, up to $200.

Household information

List all members of your household. Your utility bill must be in the name of an adult living in the household. Begin on line 1 with the account holder’s name. Please print

Name (Last, First, MI)

Social Security #

Sex

(For all in household)

(Adults only)

M or F Age

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Household

Net Income

(not including food

 

stamps)

 

Size

Annual

Month

1

$13,850

$1,154

2

$15,800

$1,317

3

$17,800

$1,483

4

$19,750

$1,646

5

$21,350

$1,779

6

$22,950

$1,913

7

$24,500

$2,042

8

$26,100

$2,175

 

 

 

Applicant’s telephone:

 

Applicant’s email:

 

 

 

 

 

 

 

Street address

City

State

Zip

County

Please indicate with a check () why you need assistance with your bill:

Not enough monthly

Loss of

Unusually high

Unusually high

income

income

utility bill

medical bill

Other (please explain)

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 3

 

 

Please list the following information from your utility bill:

Name of utility: ______________________________

Account number: ____________________________

Budget Information

MONTHLY EXPENDITURES

Amount

Regular

paid this

monthly

 

month

expenses

 

 

 

Rent

 

 

 

 

 

Electric

 

 

 

 

 

Gas

 

 

 

 

 

Water

 

 

 

 

 

Trash

 

 

 

 

 

Cable

 

 

 

 

 

Internet

 

 

 

 

 

Phone

 

 

 

 

 

Food stamps

 

 

Food (own $)

 

 

Household

 

 

Clothes

 

 

 

 

 

Laundry

 

 

 

 

 

Vehicle (payment)

 

 

 

 

 

Vehicle insurance

 

 

 

 

 

Gas/transportation

 

 

 

 

 

Other insurance

 

 

 

 

 

Credit card payments

 

 

 

 

 

Pay day loan payments

 

 

 

 

 

Student loan payments

 

 

 

 

 

Other loan payments

 

 

 

 

 

Child care

 

 

 

 

 

Medical/hospital

 

 

Tithes/contributions

 

 

Cigarettes/alcohol

 

 

Recreation

 

 

Fines

 

 

 

 

 

Other

 

 

 

 

 

TOTAL*

 

 

* Total must agree with total cash received

Total bill amount: ____________

Income Information

Name of person

Source

Amount

 

 

 

 

 

$

 

 

$

 

 

$

 

 

$

 

 

$

 

 

$

 

 

$

 

 

$

Monthly income total

 

$

 

Friend

 

Borrowed

Family

$

(check all that apply)

Payday

 

 

loan

 

Total cash

$

received*

 

*Total cash received must agree with monthly expenditures paid this month

IMPORTANT!

Please include ALL household income for all household members regardless of age or relationship.

Source examples include: employment, SSD, SSI, SS, TAF, food stamps, unemployment, worker compensation, child support, alimony, pension, VA benefits, etc.

Each source requires official written verification. Examples of verification include: paycheck stubs for most recent 30 days, letter from Social Security office (for current year), printout from DCF, printout from unemployment office, etc.

PLEASE DO NOT SEND ORIGINAL DOCUMENTS – ONLY SEND COPIES. ALL DOCUMENTS WILL BE DESTROYED AFTER REVIEW.

Please read the next page (p. 3) very carefully

Page 2 of 3

Required Verification

To have your application for assistance considered, written verification of your situation is required. Along with this signed application, you must provide COPIES of the following:

Current verification for each source of income in your household for the most recent 30 days

Current utility bill

One other utility bill or phone bill in your name at this address

DO NOT include originals as they will not be returned to you. All documents will be destroyed after review.

Notification Information

You will be notified, in writing, of our decision. Please allow up to 4 weeks to receive notification by mail. Please return completed application and verification using one of the following:

Fax: (316) 267-7778

Email: ProjectDeserve@centerofhopeinc.org

Mail: Center of Hope Inc.

Project DESERVE

P.O. Box 3237

Wichita, KS 67201

Online: centerofhopeinc.org

READ THE FOLLOWING CAREFULLY BEFORE SIGNING

My signature below means that I understand and agree to all of the following:

I understand it is my responsibility to provide current proof of all household income, a current copy of my utility bill and another monthly bill in my name to determine my eligibility.

I understand I need to continue making regular payments to my energy provider and that any Project DESERVE benefits which may be received do not take the place of my responsibility to pay the vendor.

I understand my eligibility will be determined under the Project DESERVE guidelines.

I understand this assistance is available only one time in a rolling 12-month period to those who demonstrate a financial need.

I authorize my utility provider to release my payment history and other information to Center of Hope Inc. I also authorize Center of Hope Inc. to release application information to my energy vendor.

I understand applications with incomplete information or verification will not be processed and will be destroyed.

I certify that all information I have provided is complete and accurate.

( )

Signature of adult household member

Date

Daytime phone number

Page 3 of 3

Project DESERVE

P.O. Box 3237

Wichita, KS 67201

How to Edit Project Deserve Application Online for Free

Writing the center of hope wichita ks document is not difficult using our PDF editor. Keep up with these particular actions to get the document ready without delay.

Step 1: Choose the orange "Get Form Now" button on the following website page.

Step 2: Now you are ready to edit center of hope wichita ks. You possess a wide range of options with our multifunctional toolbar - it's possible to add, delete, or change the information, highlight the specified elements, and perform similar commands.

Enter the data demanded by the platform to create the form.

example of blanks in project deserve application kansas

Type in the necessary particulars in the segment Applicants telephone, Applicants email, Street address, City, State, Zip, County, Please indicate with a check why, cid Not enough monthly, income, cid Loss of income, cid Unusually high utility bill, and cid Unusually high medical bill.

Finishing project deserve application kansas step 2

In the section discussing cid Other please explain, and Page of, it's essential to write down some essential particulars.

Finishing project deserve application kansas part 3

The Please list the following, Name of utility, Account number, Total bill amount, Budget Information, MONTHLY EXPENDITURES, Amount paid this month, Regular monthly expenses, Rent, Electric, Gas, Water, Trash, Cable, and Internet section allows you to specify the rights and responsibilities of each party.

Filling out project deserve application kansas part 4

Check the sections Phone, Food stamps, Food own, Household, Clothes, Laundry, Vehicle payment, Vehicle insurance, Gastransportation, Other insurance, Credit card payments, Pay day loan payments, Student loan payments, Other loan payments, and Child care and thereafter fill them out.

Filling out project deserve application kansas step 5

Step 3: Hit the button "Done". Your PDF form can be transferred. It is possible to obtain it to your device or send it by email.

Step 4: To stay away from potential future concerns, make sure you possess up to two or more duplicates of each document.

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