WORKSHOP/EVENT/GRANT & RESOURCES CONFIRMATION FORM

RENTAL ASSISTANCE WORKSHOP! REGISTRATION

Please complete to confirm your REGISTRATION and remember to hit "Send" at the bottom.

You will receive a confirmation of your registration.

Please call AGORA at (773) 483-3888, if you have any questions.

Do not forget to share this program with your family, friend, neighbors and associates.

THANK YOU !

AGORA _ HUD-CERTIFIED HOUSING ADVISING AGENCY

"We are Here to Serve"

Date *

Month Day Year

WHAT YOU WILL NEED: IF YOU HAVE A PROBLEM WITH ANY ITEM REQUIRED, please inform us.-- 1 Month Proof of Income for all unit occupants 18 years old and up

-- Landlord Notice showing $ Rent Due {i.e, 5-Day Notice)

-- Lease, even if expired

-- 1 Month Utility Bills (light, gas, internet and water, if applicable)

-- ID, even if expired for all adult occupants in the Unit

-- Proof of Income: {paystubs, benefit Letter} for all adults 18 years old and older

living in the Unit

-- Snap Benefit Letter, if applicable

-- Food Stamp Benefit Letter, if applicable

-- List of every month that is delinquent { Year, Month Dollar Amont Owed}

-- Signed & Dated Statement explaining how Covid-19 contributed to rent delinquency

-- An Email Address that you can check regularly

-- Landlord Info: (Management Co. Name; Owner Name; Mailing Address; Telephone

Number; Email Address

Full Name of Renter *

First Name Last Name

Section 8 Tenant? *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Employed *

Confirm Contact Phone Number *

Area Code Phone Number

Phone Type *

Can We Text Appt. Reminders? *

Type YES or NO

Email *

Please check all that you feel describes an area of assistance needed:

Request also assistance with:

Increase SAVINGS Decrease Credit Card Debt Improve Credit Legal Services Resources Budget Management Computer Assist. Session for a Housing Grant Home Repairs

Did anyone in the household apply for AND/OR receive a prior Rental Grant? *

Number of of individuals residing in Unit? *

If URGENT due to Deadline Dates, Court DATE, Etc., please provide the urgency details here.

DESCRIBE THE URGENCY or HOW YOU MAY BE CHALLENGED WITH YOUR HOUSING.

Number of household members 18 years and older. Enter -0- if -0- *

Workshop Date Preference. *