United Way of South HR

Please select one of the following to describe yourself:*
- Small Business
- Nonprofit Organization
- Individual or Household

Please enter your ZIP code:*
Which of the following circumstances related to COVID-19 apply to you or your household?*
- Loss of employment or decreased hours
- Decrease in wages or earnings
- Unexpected expenses
- No childcare
- Contracted virus
- High risk of infection
- Lost child/spousal support
- Inability to find work
- None of the above

Before identifying your needs, please provide some general information. You will select types of services and assistance in the next section. Your contact information will be shared with relevant partners to connect you to resources.
Name*
First Name Last Name
Email*
Phone*
Your Home Address*
Street 1 Street 2 City State Zip
Birthdate*
Date Format: MM slash DD slash YYYY
Are you currently employed?*
- Yes, Part-Time
- Yes, Full-Time
- No
I am interested in receiving a phone call from a trained care coordinator to discuss available resources.
I am a veteran or military-connected family member.
Have you already applied to VBrelief in the past 90 days?*
- Yes
- No
If you have already applied, you cannot reapply for the same category/provider. However, if you would like to submit an application for assistance with new categories and/or providers, we may be able to help.

Please check next to the boxes below that describe your needs and complete the questions associated with each need.
The Hampton Roads Workforce Council has fully obligated all VBrelief funds for training services at this time. If you are interested in workforce development or training services, still complete that section of the form and we will contact you if additional funds become available.
FRAUD ALERT: Beware of scams and always protect your personal data. While we may need a copy of a bill for specific types of assistance, our team will never request your banking information or social security number.
Food
Within the past 12 months, were you worried about whether your food would run out before you got money to buy more?
Yes
No
Within the past 12 months, did the food you bought just not last and you didn’t have money to get more?
Yes
No
Are you eligible for any federal nutrition programs? Check all that apply.
Supplemental Nutrition Assistance Program (SNAP)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Child and Adult Care Food Program (CACFP)
Summer Food Service Program
National School Lunch Program, School Breakfast Program or Special Milk Program
Are you currently participating in any federal nutrition programs? Check all that apply.
Supplemental Nutrition Assistance Program (SNAP)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Child and Adult Care Food Program (CACFP)
Summer Food Service Program
National School Lunch Program, School Breakfast Program or Special Milk Program
Employment
Are you interested in receiving education and/or training?
Yes
No
In what?
Do you have reliable transportation?
Yes
No
Housing Assistance
Property Manager (Company or Landlord)*
Company / Landlord Mailing Address for Payment:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please enter the company address where we can mail a payment. (This may be listed on your bill or lease.)
Balance Due*
Upload a copy of your housing bill*
Drop files here or
Accepted file types: jpg, jpeg, gif, png, pdf.
Please upload a copy of your bill that includes your address, the amount owed, and a landlord/property management address where we can mail payment. Acceptable documentation includes: a notice of rental arrears (listing balance due), your lease (listing a monthly payment), or another invoice from your landlord or property manager. You may upload a PDF document, photograph, or screenshot of the document.
Given the quantity of requests we've received and the time it takes to process and pay each bill, it may take three to four weeks to complete your assistance. If you are experiencing a housing crisis and need immediate help, please call the Housing Crisis Hotline at 757-587-4202.
Utilities
Cox Communications
For financial assistance for Cox Communications accounts, we require your account number and balance due. Account numbers must match the household address you entered on your application.
Account number*
Please enter the total amount due on your Cox bill:*
(Optional) Please upload a copy of your Cox bill
Accepted file types: jpg, jpeg, gif, png, pdf.
If we are unable to match your account number, we may be able to use a Cox bill to may a payment on your behalf. You may upload a PDF, photograph, or screenshot of your bill.
Dominion Energy
For requests for assistance for Dominion Energy accounts, we require a copy of a bill with an updated balance as of January 2021 or later. Please enter your account number and balance due as they appear on your bill.
Dominion Account Number*
Please enter the total amount due on your Dominion bill:*
Upload a copy of your Dominion Bill*
Accepted file types: jpg, jpeg, gif, png, pdf.
Please ensure that your Dominion bill is dated January 2021 or later, and contains your name, address, account number, and the total amount due.
Hampton Roads Sanitation District (HRSD)
For assistance requests for Hampton Roads Sanitation District, we require a copy of a bill with an updated balance dated January 2021 or later. Please enter your account number and balance due as they appear on your bill.
HRSD Account Number*
Please enter the total amount due on your HRSD bill:*
(Optional) Please upload a copy of your HRSD bill
Accepted file types: jpg, jpeg, gif, png, pdf.
If we are unable to match your account number, we may be able to use a HRSD bill to may a payment on your behalf. You may upload a PDF, photograph, or screenshot of your bill.
Verizon
Verizon
VBrelief may be able to provide financial assistance for Verizon services (wireless, phone, and internet). For requests for assistance for Verizon accounts, we require a copy of your bill.Please ensure that the bill contains: your name, the balance due, and the Verizon company mailing address where we can send payments. VBrelief is unable to send electronic payments for Verizon bills at this time.
Please enter the total amount due on your Verizon bill:*
Please upload a copy of your Verizon bill*
Accepted file types: jpg, jpeg, gif, png, pdf.
Please ensure your Verizon bill includes your name, the total balance due, and an address where our finance department can mail payment.
Virginia Natural Gas
For assistance requests for Virginia Natural Gas, we require your account number and total amount due on your account. Account numbers will be verified using the household address you provided in this application.
Virginia Natural Gas Account Number*
Please enter the total amount due on your VNG bill:*
(Optional) Please upload a copy of your Virginia Natural Gas bill
Accepted file types: jpg, jpeg, gif, png, pdf.
If we are unable to match your account number, we may be able to use a VNG bill to may a payment on your behalf. You may upload a PDF, photograph, or screenshot of your bill.
Another Utility Provider
VBrelief may be able to provide financial assistance for bills from providers not listed above, who provide services such as water, electric, or phone/internet services.
Utility Provider*
Please enter the name of the company to which you owe the utility/household bill.
Please enter the total amount due on your bill:*
Utility Provider Mailing Address for Payment*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please enter the company mailing address (listed on your bill or payment stub) where we can mail payment on your behalf,
Please upload a copy of your bill*
Accepted file types: jpg, jpeg, gif, png, pdf.
Please ensure your bill includes your name, the total balance due, and an address where our finance department can mail payment.
Childcare
Which of the following applies to you?
I need help finding childcare
I already have childcare but need help paying for it
Need help finding childcare? Visit Childcare Aware of Virginia to search for childcare or connect with assistance.
Number of children
Childcare Provider:*
Please enter the name of the provider to whom we should mail payment.
Balance due:*
Provider Mailing Address for Payment*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please enter the company mailing address where we can mail a payment on your behalf.
Please upload a copy of your childcare bill*
Accepted file types: jpg, jpeg, gif, png, pdf.
Please ensure your bill includes your name, the total balance due, and an address where our finance department can mail payment.
Health & Mental Health
If COVID-19 has impacted your ability to pay your medical bills, VBrelief may be able to make a payment directly to your provider.
Which of the following applies to you?
I need help paying my medical bills
I need help accessing medical care
I need help accessing mental health services
Medical Provider / Company:*
Please enter the name of the organization where we can mail payment (listed on your bill).
Balance due:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please enter the company mailing address listed on your bill or payment stub.
Please upload a copy of your bill*
Drop files here or
Accepted file types: jpg, jpeg, gif, png, pdf.
Please ensure your bill includes your name, the total balance due, and an address where our finance department can mail payment.
By signing the box below, you confirm that the information you have entered above is accurate and you are eligible to receive assistance—you are 18 years or older of age, you are a resident of Virginia Beach, and you have experienced a COVID-related impact.
Your signature additionally confirms your consent to allowing the Virginia Beach Pandemic Relief Partnership to share the information you have provided with relevant service providers and organizations for the purposes of providing assistance and connecting you to the resources you have requested.
Signature*

Get Started

Step 1 of 4

VBrelief.org is a partnership of:

CONTACT

If you have questions or need assistance with completing the form,
please call 757-774-6264

Get Started

Step 1 of 4

VBrelief.org is a partnership of:

CONTACT

If you have questions or need assistance with completing the form, please call 757-774-6264

If you have questions or need assistance with completing the form,
please call 757-774-6264