RENT ASSISTANCE APPLICATION
Africatown Community Land Trust (ACLT) stands with our community during this unprecedented time. In continuing our work to ensure that the our community continues to grow and thrive in place, ACLT’s Build AfricaTown COVID-19 Response Fund (The Fund) serves our community’s renters, homeowners and small business owners.
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Your Name
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First Name
Last Name
Your Phone Number
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-
Area Code
Phone Number
Your Email
*
example@example.com
Your Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I am applying for assistance as a:
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Renter
Homeowner
How did you hear about our Covid-19 Rental Assistance Program?
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Instagram
Facebook
Twitter
Friend/Acquaintance
Other
If you selected 'Other' above, please specify how you heard about the Rental Assistance Program.
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Your Landlord/Mortgage's Name
*
First Name/Company Name
Last Name
Landlord/Mortgage's Phone Number
*
-
Area Code
Phone Number
Landlord/Mortgage's Email
*
example@example.com
Your Landlord/Mortgage's Mailing Address
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Street Address
Street Address Line 2
City
State
Zip Code
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How have you been financially impacted by COVID-19?
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Have you applied for any other financial relief programs? Please elaborate.
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Please describe ways you contribute or have contributed to the community in the past.
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Do you want to contribute to recreating a thriving Black community in the Central District and Seattle area? If YES, please briefly describe any skills, training or talent that you have to offer.
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Please mark all that apply to your current source(s) of income.
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Full-Time Employee
Part-Time Employee
Artist/Creative
Self-Employed/Entrepreneur
Non-Profit
Other
Do you or anyone in your household have access to unemployment, paid time off, sick time, FMLA, FFCRA, or EFMLEA benefits?
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Yes
No
Did you or anyone in your household obtain the Federal Stimulus Package assistance that could be applied to your monthly rent/mortage or business expenses?
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Yes
No
Is a member of the household still working?
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Yes
No
I am a:
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Current Central District resident
Past Central District resident
Neither
Check all that apply:
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I would like information about resources, activities and events from Africatown
I would like to volunteer
I am willing to share my story regarding the impact of COVID19 pandemic on my life
N/A
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Proof of Documentations
These are documents that must be uploaded below to be considered complete.
Upload Proof of application to other relief programs here:
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Upload Lease Agreement/Mortgage Documents here:
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This can be a PDF or picture of your lease or mortgage documents.
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Upload Backup Documentation here:
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This can be a PDF or picture of your utility bill, two pieces of mail, or receipt of payment.
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