Application for Rent Assistance

Application for Rent Assistance

Required Documents: Photo ID, Monthly Statement or Late Bill, Lease Agreement, Property Owner Form W-9.
Rent Assistance Policy

We require a late rent statement or a monthly bill. Your rent must be past due or due within 48 hours, from today. Must live in CCF Service Area(Sapulpa, Kellyville, Kiefer, East Creek Co). 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. CCF does NOT assist with Mortgage Payments, Lease to Own, or Rent to Own.
This is an application for Emergency Rental Assistance. CCF requires a Late Bill or Monthly Statement. Rent must be late or due within 48 hours from Today - Please do not apply unless / until your Rent is already past due or is due within the next 48 hours. Do you understand that your application will not be approved without meeting this requirement?*

YesNo
Date

MonthDayYear
Date
Where do you live?*

SapulpaKieferKellyvilleCreek County Resident with Tulsa AddressCreek County Resident with Mounds AddressCreek County Resident with Oakhurst AddressOther - Call 211 or go to www.211EOK.org to find help in your local area.

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?*

YesNo
Are you renting a house or apartment?

HouseApartment
What is the name of the homeowner - or - apartment complex?
What is your Landlord's Name?*
Landlord's Contact Information

Please include a phone number or email for your landlord.
Landlord's Phone Number
Please enter a valid phone number.
Landlord's Email
example@example.com
Photo Upload*

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Proof of Income. If zero, please move on to the next question.

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What is your monthly rent amount?
Lease Agreement First Page (Showing Name and Address)*

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Lease Agreement Signature Page *

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What is the total amount owed (including past due and late charges)?
Late Rent Notice, Rent Bill, Monthly Statement. If you do not have late notice or monthly statement, please reach out to your property owner. (Must include: Name, Address, Due Date, Amount Due and Property Owner's Name or Apartment Complex). *

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Property Owner Form W-9

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Do you understand that this agency is only able to assist with up to $250. If your application is approved, you are still responsible for any remaining balance.*

YesNo
I understand that I must submit all of the documents, listed above, to complete my application.*

YesNo
Applications must be complete and include the proper documentation. It generally takes between 1-3 business days for us to process your application. If the application is approved, we will contact your landlord to issue a pledge. Payment will mailed directly to the property owner.
Questions | Comments? Use the space below or call: 918-224-6464 (M|W|F), email: info@ccfok.org, or inquire in-person: 12 W. Burnham (M|W|F). Client Service hours Monday, Wednesday, Friday: 9:30 - 12:00 p.m. and 1:00 - 3:00 p.m.
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Application for Rent Assistance

Rent Assistance Policy

Personal Information

Household Information

Documentation

Landlord's Contact Information