Emergency Housing Assistance Form, June 2025 Flooding
*Note: At this time, households that have been displaced will receive priority. Funding can pay security deposits, utility set-up, and rent through September, as available. Homeowners should report any flood damage through the VOAD Damage Assessment Survey at https://survey123.arcgis.com/share/de033ec0327f4a5db41884eb5fc0974b
Are you a renter or a homeowner?
*
I'm a renter
I'm a homeowner
Have you been displaced from your home because of recent flooding?
*
Yes
No
If you have been displaced, where are you staying? (Ex.: Local hotel, with family, etc.)
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.
Format: (000) 000-0000.
Email
example@example.com
Housing Assistance Type Needed
*
New Rental
Past-Due Rent on an Existing Rental
Utilities
Other (Please Specify Below)
Other Housing Needs Required
Permission to Share Information: The Applicant and any co-applicants and residents 18 years and older (if any) included on this application (individually and collectively, "Applicant"), authorize the WVHDF to share, release, discuss, and otherwise provide any information included in this application to potential landlords, utility companies, or other entities seeking to provide housing assistance to the Applicant.
*
Yes, I grant permission for the West Virginia Housing Development Fund to share my information.
No, do not share my information.
Submit
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