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2. City of Durham - Water Hardship Fund
4. Are you are struggling to pay your water bill? The City would like to help through the Water Hardship Fund. The fund is intended to assist with past due utility balances, but it cannot be used for penalties, fees or other fund charges. Through a simple online process, you can apply for up to $240 in assistance per fiscal year if you are having a documented hardship, have past-due bills, and are in danger of having your water cut off. If you think you might qualify, please complete the Water Hardship Fund application form. Please continue to make any possible payment towards your account as you may be asked to pay up to 20% of your past due balance even if approved. If contacted, you may be asked to provide identification, proof of income, a copy of your water bill, and other information.
6. Name on Water Bill:*
8. Your Name:*
10. Address on Water Bill:*
12. Account Number on Water Bill:*
14. Primary Phone Number:*
16. Email Address:*
18. How many people are in the home?*

    1. 1
    2. 2-3
    3. 4+
20. What is causing the hardship you are currently experiencing? (Select all that apply.)*

    1. Unexpected high bill due to a leak
    2. Unemployment / Job loss
    3. Personal or Family illness
    4. Unexpected / Emergency Expenses
    5. Other
22. Please Explain
24. Is the hardship temporary or ongoing?*
    -- Select One --This is a temporary hardshipThis is an ongoing hardshipThis is a permanent hardship
26. What is your current water status?*

    1. Turned Off
    2. Past Due and in Jeopardy of being turned off
28. What is your current balance due?*
32. Internal Use Only
34. Form Initiated By:
    -- Select One --Durham ResidentDepartment of Social ServicesWater Management Department
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field