Utility Assistance Form

Name: *

To be eligible for utility assistance, the client must have sickle cell disease and be a resident of Davidson County or Shelby County, Tennessee.

Client must present a valid picture ID in addition to the utility bill for assistance.

The client must present a DISCONNECT notice in order to receive assistance. Additionally, client must allow The Sickle Cell Foundation of Tennessee (SCFT) staff and/or representative to contact the utility agency for verification.

Each client can receive a maximum of up to $100.00 per calendar year. Funds are distributed on a first come first serve basis. If the client chooses not to use the full amount of $100.00 at one time, there is no guarantee that the unused portion will be available for subsequent requests.

These funds shall be used as the payer of last resort; therefore, clients must exhaust other community resources prior to receiving utility assistance through The Sickle Cell Foundation of Tennessee (SCFT). Proof shall be presented in the form of denial letters from those community agencies.

Please upload all relevant files here.

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Referred by: *

I clearly understand the Utility Assistance policy and agree to the aforementioned guidelines. *