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City of Gadsden Community Development COVID-19 utility assistance program application. You can fill out this form online or pick up a form at the City of Gadsden - City Hall 90 Broad Street, Gadsden, AL 35901. If you have questions about this form or program call Community Development Planner Renee Baker (256) 549-4532.
(List applicant information on line 1 below and list information on EACH person in the household on lines 2-10)
Race: enter the number that best describes you.
Enter the total number of persons in the household that are of Hispanic origin
By checking one of the statements below – you may be required to provide proof to document the statement.
Income (income BEFORE any deductions such as taxes, insurance, etc.)
List for each person as listed above and include any alimony, child support, COVID-19 pay, Unemployment, Worker’s Compensation, Social Security, Disability, VA benefits, TANF/WIC, pension, retirement, etc.)
I was employed in a position working ____ when COVID-19 restrictions were imposed by the Alabama Governor.
My job title at my employer prior to COVID-19 restrictions were put into place was:
My employer has guaranteed my return to employment once the COVID-19 restrictions are fully lifted and I AM receiving unemployment compensation.
My employer has contacted me to return to work and has guaranteed return to my previous position and scheduled hours.
My employer has not guaranteed my return to employment and I am NOT receiving unemployment compensation
I returned to work
Check All That Apply
(Describe the need for assistance and how the household has been affected by the COVID-19 pandemic
In order to finalize this application, you must fill out an Authority for Release of Information Form at the Community Development Office. This cannot be completed online.
After submission of this form you will be contacted by the Community Development office at the City of Gadsden. If you are not contacted you can follow up with Community Development at (256) 549-4532.
This field is not part of the form submission.
* indicates a required field