• Rent Well

    Housing Stability Services - Registration Form


  • 211 SE Byers Ave
    Pendleton, OR 97801
    541-276-1926 | 800-752-1139

     

    Serving Gilliam, Hood River, Morrow, Sherman, Umatilla, Wasco, and Wheeler counties

  • While completing this form, provide information about yourself and your situation as of TODAY.

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  • This Rent Well registration form is for Oregon residents living in Gilliam, Morrow, Umatilla or Wheeler counties only. If you live outside these counties please contact an agency working in your county of residence - See a list of Rent Guarantee Program Contacts online.

  • 2026 Rent Well Program Sessions:

     
    Dates: Wednesdays, March 11, 18, 25 & April 1 
     
    Time: 8:30 am - 12:30 pm
     
    Location: CAPECO Office - Hermiston, OR
     
    Address: 1565 N 1st St. Ste. 1, Hermiston, OR 97838
     
    Classes held in English
     
    NOTE: To participate, you must attend the first session!
     
    Register soon, before this session fills up!
     

  • Registration Information

  • Please tell us who is in your household:

  • List ALL household members here.

    Start with yourself, then click the "+ Add More" button to add more household members to your list.

  • If you are not filling in all required fields for the questions on this form you will receive an error message.

    To be able to move through this form you will need to fill in all required fields.

    You may need to use the scroll bars to reveal all required fields above.

     

  • What is your race/ethnicity?

    *Why do we ask this? HUD asks us to collect this information to make sure that laws that protect people from being discriminated against are followed. If you are uncomfortable sharing this information, please check “prefer not to answer”.

  • Education & Employment

  • Health & Wellbeing

  • Current Housing Status

    Review the following statements. Check any statement that fits your current living situation.


  • Housing Barriers

  • Income

    If you have any income, please list it below.

  • For each type of income below provide the total amount you receive each month:
    Earned Income / Wages   *   
    TANF / AFDC *
    Child Support   *      
    Unemployment   *   
    SSI / SSDI   *   
    Pension   *   
    Worker's Comp       *   
    WIC benefits   *   
    SNAP / Food Stamps   *   
    Non-cash benefits   *   
    Other   *     

  • I hereby certify that I receive ZERO income/money from any source, including, but not limited to, income from wages, public assistance, social security, pensions, benefits, child support, alimony, self-employment, or regular gifts.

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