Application for Rent Assistance
Required documents may be uploaded directly to this application, emailed to info@ccfok.org, faxed to 918-224-6426, or submitted in-person at 12 W. Burnham
Rent Assistance Policy
Must live in CCF Service Area. Lease must be in your name and current address (or in the name of a current member of your household). Assistance amount up to $250 / per household / per 12 months.
Date
-
Month
-
Day
Year
Date
Where do you live?
*
Sapulpa
Kiefer
Kellyville
Creek Co. Resident with Tulsa Address
Creek Co. Resident with Mounds Address
Creek Co. Resident with Oakhurst Address
Other - Call 211. If you live outside of our service area, you are not eligible for financial assistance from Caring Community Friends. Please go to www.211EOK.org to find help in your local area.
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Personal Information
Full Name
*
First Name
Last Name
Date of Birth
*
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Year
What gender do you identify as?
Male
Female
Prefer not to answer
What race of ethnicity do you identify as?
White
Hispanic, Latino, or Spanish
American Indian
Black or African American
Asian
Other
Don't Know / Prefer not to answer
Which Tribe?
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Telephone Number
Household Information
Not including yourself, how many Seniors (55+ yrs) live at your address?
What are their Names (first and last) and Ages?
Not including yourself, how many Adults (18-54 yrs) live at your address?
What are their Names (first and last) and Ages?
Not including yourself, how many Children (0-17 yrs) live at your address?
What are their Names (first and last) and Ages?
Has anyone in your household, including yourself, served on active duty in the U.S. Armed Forces?
No, never served in the U.S. Armed Forces
Yes, on active duty in the past, but not now
Yes, now on active duty
Is anyone in the household currently receiving SNAP/Food Stamps?
Yes
No
Don't know / Prefer not to answer
Total Monthly Household Income
*
Does anyone in your household, including yourself, have a disability?
Yes
No
Don't know / Prefer not to answer
What is your living situation, today?
I have a steady place to live
I have a place to live today, but I am worried about losing it in the future
I do not have a steady place to live.
Don't know / Prefer not to answer
In the last month, did you or anyone in your household work for pay full-time?
Yes
No
Don't know / Prefer not to answer
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Documentation
Please submit a copy of your 1) Federally Recognized Photo ID 2) Lease Agreement 3) Bill or Late notice (showing total amount due) 4) Form W9 for the property owner.
Is the Lease in Your Name and Address, as shown on your Photo ID?
*
Yes
No
Are you renting a house or apartment?
House
Apartment
What is the name of the apartment complex?
What is your Landlord's Name?
*
What is your Landlord's Phone Number?
*
Please enter a valid phone number.
ID Card Upload
*
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Proof of Income (paystub, social security, bank statement, etc.) If zero, please move on to the next question.
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Lease Agreement First Page (Showing Name and Address)
*
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Lease Agreement Signature Page
*
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Late Rent Notice or Bill (showing amount due)
*
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Property Owner Form W-9
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I understand that I must submit all of the documents, listed above, to complete my application.
*
Yes
No
Submit
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