SPCI Rent/Mortgage Assistance Program Information and Application
Please review the rent and mortgage assistance program guidelines below. The application should only be submitted if you meet the qualifications. You will be required to complete both financial literacy quizzes, as well as submit your original documents during your in-person intake interview. All verification documents must be submitted during your appointment. No Exceptions!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Place of employment, including company name and address:
*
What is your annual household income?
*
Number of people living in your household, including yourself:
*
2
3
4
5
6
7 or more
Do you rent your home or do you have a home loan (mortgage)?
*
Rent
Home Loan/Mortgage
What is your monthly rent or mortgage payment amount?
*
What day of the month is your rent or mortgage payment due?
*
List the amount of money you owe to become current on your rent or mortgage payment:
*
What is the name of your landlord, leasing company, or mortgage company? The property owner must be a registered leasing company or agent who is licensed in the State of Indiana. This is the entity we would pay directly.
*
What is the address of your landlord, leasing company, or mortgage company? Be sure to include any unit or suite numbers.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide the contact name and phone number for your landlord, leasing company, or mortgage company.
*
The following documentation must be submitted, during your in-person interview, in order to verify eligibility for this program. Please email info@singleparentconnection.org to schedule your appointment. SPCI will send a confirmation email with your scheduled date and time, after your request has been received. Please refer to the program guidelines for a detailed list of required documents. Place a check mark in each box below to indicate that you have the required documents to qualify for this program. Thank you.
*
Proof of Residence
Proof of Single Parent Status
Proof of Employment and Income
Proof of Urgent Need
Completed Financial Literacy Quiz (will be required after eligibility has been verified)
Submit
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