Please Note
Upon application receival, an email with community resources will be sent out. If eligible, you will receive a follow up call to begin the process; please do not inquire about updates regarding your application unless contacted. Note that from submitting the initial application to receiving rental assistance, the process can take several weeks.
Email
*
example@example.com
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
What are your pronouns?
*
What gender do you identify as?
Race
What is a safe contact number for you?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever been in foster/state care?
Yes
No
Are you a survivor of sex and/or labor trafficking?
*
Yes
No
I need assistance answering this question.
Do you currently reside in Washington State?
*
Yes
No
What is your main reason for submitting this application?
*
Please Select
Facing Eviction
Move-in Costs
Homelessness
Rental Assistance
What type of financial assistance do you require?
*
Rental Support
Move-in costs
Temporary Hotel Stay
Other
Have you received rental assistance from Rebuilding Hope in the past?
*
Yes
No
Are you currently receiving rental assistance from any other agency?
*
Yes
No
If you have been referred to our program by another agency please provide details here.
(Please sign consent to share information below if you fill in this field)
When was the last time you were able to pay your rent without assistance from other agencies?
*
My signature below authorizes Rebuilding Hope staff to communicate with the referring staff/agency listed above about my participation in receiving rental assistance. This authorization expires on June 30th 2026.
If you require rental support or assistance with move-in costs, please complete the below questions.
Please note N/A (not applicable) if these questions do not apply to you.
Who do you pay your rent to?
*
Please Select
Property Management Company
Other commercial landlord
Private Landlord
I need assistance with answering this
N/A
What type of building is the property?
*
Please Select
House
Apartment or condo
Community building or shared living
Room in a private residence
Other
N/A
Please provide the address for the property.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does anyone else live at the address with you?
Please Select
I live alone
Children
Spouse or Partner
Other
Please provide a name and contact details for your property management company or landlord (whoever you pay rent to).
*
Do you consent for Rebuilding Hope to contact the property manager or landlord you have listed on your behalf? (We will need to contact them to proceed with your application)
*
Yes
No
N/A
My signature below authorizes Rebuilding Hope staff to communicate with the landlord listed above about my lease and participation in receiving rental assistance. This authorization expires on June 30th 2026.
Please briefly explain why you require rental assistance?
*
What amount of money ($ - USD) are you requesting?
*
Please explain how you plan to continue paying for future housing if we are able to assist you on this occasion?
*
If you would like to share details of your monthly budget with us (incoming and outgoing payments) please provide details here.
My signature below authorizes Rebuilding Hope staff to communicate with the Office of Crime and Victims Advocacy (OCVA) about my application to receive rental assistance. This authorization expires on June 30th 2026.
*
I attest that the information I have provided in this application is true and accurate to the best of my knowledge, and that if there is a suspicion of fraud, I give Rebuilding Hope permission to share my information provided in this application in order to investigate.
*
Please provide the dates and times you are available for a follow-up phone call.
Submit
Should be Empty: