Online Forms

Please use the fields below to send Monterey One Water your request. Don't forget to hit the "Submit" button when you are done.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Pre-Screening: COVID-19 Emergency Utility Assistance Program

  1. If you do not have an email address, type none

  2. Property Type*

  3. Type of Income*

  4. Have you lost your job or had your work hours reduced due to COVID-19?*

  5. What sex does the customer identify as?*

    United Way reporting requirement

  6. What ethnic category does the customer identify with?*

    United Way reporting requirement

  7. What racial category does the customer identify with?*

    United Way reporting requirement

  8. Active Referral Network*

    Would you like to opt-out of having your referral history and averaged client scores made available to other service organizations in the Active Referral Network? Network organizations use service history information to coordinate with other organizations and make referrals based on your service needs. *Referrals categorized as health related will always be private.

  9. 2-1-1 Smart Referral Network Electronic Signature Agreement*

    This online consent authorizes United Way Monterey County’s Smart Referral Network (“The Network”) to make a referral to a member organization of the Network and your consent to the release of the following personal information: name, age, gender, ethnicity, race, income, city/county of residence, language, disability, veteran status, education, rent and utility status, and contact information. Your information will be shared with our partner organizations in the Network, including the services you have received, and you can expect to be contacted by one or more of the organizations in The Network to receive services that meet your specific needs. Your client information is not shared with the federal government through The Network or its database. Your information will be kept confidential by the organizations that provide the additional services to you. Participation in the Smart Referral Network comes at no cost to you and allows for referrals, care coordination, outreach, education, and targeted services with your consent. You have the right to access and verify your personal information, to receive a list of organizations belonging to The Network, to restrict release of your information to certain member organizations, and to revoke your referral authorization and consent to release of information at any time. Your consent is valid for 12 months from the date given. To revoke your authorization please contact the person who made the original referral for you. Please indicate your consent by checking “yes” to confirm your consent.

  10. Leave This Blank:

  11. This field is not part of the form submission.