Rent Assistance Application

Rent Foundation Application
You must complete this form in its entirety and include ALL required supporting documents. Incomplete applications will not be considered.

Contact: rentfoundation@gdaa.org

Applying does not guarentee assistance.

Today's Date*

MonthDayYear
Date
Amount Requested*
Month Requested*
YesNo
If yes, when? (Month/Year)
Applicant Full Name*
Applicant Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email Address*
example@example.com
Co-Applicant Full Name
Co-Applicant Email Address
example@example.com
Co-Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Household Information
Single ParentTwo-Parent HouseholdSingle PersonAdults/No ChildrenMultigenerational Household
List the Name and Age of everyone in the household. (List Applicant First)*

Applicant Full NameAge
Full NameAge
Full NameAge
Full NameAge
Full NameAge

List MONTHLY income for everyone on the lease or that contributes to the household.

Enter 0 if it doesn't apply.
Applicant Income (Employment/Unemployment)*
Co-Applicant Income (Employment/Unemployment)
SSI/Disability*
Social Security*
SNAP (Food Stamps)*
Child Support*
Other financial assistance*
Total Monthly Income*

Describe in as much detail as possible why you are unable to pay your rent. Please provide more than 4 sentences. If you or your co-applicant are unemployed, please provide the reasoning here.*
What is your plan to pay rent on time moving forward? Provide as much detail as possible. More than 4 sentences.*
Documentation is necessary to support your reason for why you need assistance. All Documents must be legible. You may submit any documentation that is relevant to your situation. Copies of current income, pay stubs, unemployment, SSI, doctor bills, medical bills, doctors orders, crime investigation, theft reports, court orders, etc. *

Cancelof

Check to agree to the following:*
My signature and submission of this application means I give the GDAA Rent Foundation representatives permission to obtain any information requested and verify all information provided; including contacting my landlord, employer, or anyone contributing to the monthly income, or providing assistance.
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
Signature of Co Applicant

Clear
Date

MonthDayYear
Date
Should be Empty:

Rent Foundation Application