Apply for our Programs

Apply Here

.
Please note: we will review applications as they come in.

We have extended our deadline for Application submissions to January 31, 2024

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

What is the best way to communicate with you? *

What is the name of the person on the Cape Fear Public Utility Authority water (CFPUA) account for which you are applying? *

If your name is not the name on the account, what relationship do you have to the person who is on the account? *

What is the address of the home on the CFPUA account? *

What is the CFPUA account number for the home you are applying for? *

Do You Rent or Own? *

How much a month do you pay for rent or mortgage? Please specify the exact amount. *

How many adults and children regularly live in the home? *

How much income did your household receive last month? (We may require documentation to support your answer in the future, so please be as accurate as possible) *

If no income was received last month, why not? *

How much was your most recent CFPUA bill? Please include any fees as well. *

How many times per year do you have trouble affording your water bill? *

Have you ever had to choose between paying your water bill and paying for another service? (Ex: electricity, childcare, phone bill) *

If you had to estimate, how much financial assistance would you need on your bill each month to make it comfortably affordable? *

If you are approved for our program, do you acknowledge that we will pay only a portion of your bill each month and that you will still be responsible for paying the remaining *

If you are approved for our program, do you agree to complete monthly surveys that will ask you to share information with us on your monthly costs, expenses, income, and affordability challenges? *

NOTE: MONTHLY SURVEYS ARE A MANDATORY REQUIREMENT. IF SURVEYS ARE NOT COMPLETED, WE WILL REMOVE PARTICIPANTS FROM THE PROGRAM AND WILL CEASE TO PROVIDE FURTHER FINANCIAL ASSISTANCE.

Do you attest that all of the information you have provided here is accurate and true? *

Please select submit to send your application. Thank you.

I agree to receiving marketing and promotional materials *

Submit

Apply Here.​Please note: we will review applications as they come in. ​We have extended our deadline for Application submissions to January 31, 2024

Apply Here

.
Please note: we will review applications as they come in.

We have extended our deadline for Application submissions to January 31, 2024