Rental, Mortgage, & Utility Housing Assistance

Eligibility
This program is intended to help households through an unexpected financial hardship. Currently, only the below hardships are eligible for funding:

Medical hardships during the last 6 months
Unexpected car repair over $200 during the last 6 months
Loss of spouse or other income earner during the last 6 months
Taking on legal guardianship of a minor or other person during the last 6 months
Unexpected loss of job during the last 3 months

Ineligible Use of Funds
This program cannot be used for hotel rooms, rental deposits, down payment assistance, set-up fees, medical payments, credit card/auto/other loan payments, inflation, or anything besides rent, mortgage, and utilities.

You will be asked to provide documentation of the hardship that has taken place and hardship must have happened in the last 3-6 months. Hardships incurred prior to time frame cannot be funded at this time.

Failure to turn in requested documents means the application is incomplete and will not be considered for funding.

Name of Primary Applicant*

First NameLast Name

Please submit a clear, readable copy of the front of your current ID. Feel free to black out the driver's license # and birthdate. Make sure it is not blurry. *

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How many reside in your home?*

Address (This should be the property the applicant resides in and should match the address on the lease, deed, and utility statements.) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Email Contact (This is how we will primarily communicate about your application status.)*

example@example.com

Phone Number*

Area CodePhone Number

Has your household received financial assistance from us in the most recent 18 months?*

YesNo

If your household has received financial assistance from us in the most recent 18 months, you are not eligible currently to receive financial assistance under this program.

What type of assistance are you applying for? (Check no more than 2)*

Rent PaymentUtility PaymentMortgage Payment

Which eligible hardship are you applying under and submitting documentation for? (Check 1)*

Medical Hardship in the last 6 monthsCar repair over $200 in the last 6 monthsLoss of spouse or other income earner in the last 6 monthsTaking on legal guardianship of a minor or other person in the last 6 monthsUnexpected job loss in the last 3 months

Please submit a clear, readable document that proves the hardship checked above. If you are unable to provide documentation, the application is considered incomplete. Please feel free to black out sensitive information such as social security #s, driver's license #s, birthdates, type of procedure, description of disability, etc. We simply need to be able to see a financial hardship has occurred and can be attributed to your identity. Examples of acceptable documentation can be found at https://ccihomes.org/examplesRUPA *

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Request Description. Please briefly describe how this assistance would benefit your household.*

How much financial assistance are you requesting total?

$1 - $250$251 - $1,000$1,001 - $1,500Over $1,500

Please upload a clear, readable copy of the bill you are requesting help with. If it is rent, submit the page(s) of the lease agreement that state your name, rental property address, the landlord's name and mailing address, and the amount of rent due per month. If it is mortgage, submit your most recent mortgage statement that shows company name and address, your name, property address of mortgage, and amount due per month. If it is a utility, submit the most recent utility billing statement that shows utility company name and address, your name, property address of utility, and amount due.*

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When you submit this application, you may be asked to provide Supporting Documentation. Are you willing and able to do this? (Please do not submit this application unless the answer is "Yes".)*

YesNo (please do not submit your application unless your answer is Yes.)

Rental, Mortgage, & Utility Housing Assistance

Contact Information

Financial Assistance