SI Rent Assistance Application Form

SI Rental Assistance Application

To apply for rental assistance, please complete the following questions.
Are you a city of McKinney, TX resident?

Applicant Information
Applicant Name

First NameLast Name
Does your name match the name on the lease agreement? If not, whose name is on the lease? *You will be required to show documentation that you are an authorized user on the account.
Home Address
This address should be the same as on your lease agreement
Apt Number
City
State
Zip Code
Phone
Email Address
example@example.com
Email Address (please type again)
example@example.com
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Applicant Sex
Applicant Race
Are you Hispanic or Latino?

Required Documents

Please upload clear photos of the following documents.
2. Upload Proof of ID for all lease holders

Driver License or ID, US Passport
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2. Upload lease agreement

Copy of lease agreement. Name & address must be visible.
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3. Upload Your Late Rent Invoice/Notice/Ledger

Most recent invoice or notice (Account name and account number must be visible.)
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The Samaritan Inn Agreements
I understand that submitting this application does not guarantee assistance or approval from The Samaritan Inn, as rental assistance is contingent upon eligibility, availability of funds, and a qualified zip code.
I understand that failure to submit all required documentation or fully answer all application questions will result in an incomplete application.
I understand that by submitting this application I am authorizing The Samaritan Inn to contact my landlord and access my rental account as well as authorizing my landlord to release information to The Samaritan Inn.
I understand that all information received in this application, as well as any documents received by The Samaritan inn staff throughout this process is subject to the organization’s Privacy Policy.
By signing this application, I hereby certify that all information provided is true, complete, and accurate to the best of my knowledge at the time of application.
Name
Please Type Full Name
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant Signature

Draw your name above with your finger or mouse.

Based on your response, you are not eligible for assistance at this time.

At this time you must be a Mckinney resident.

If you believe this is an error, please contact us at assistance@saminn.org.
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SI Rental Assistance Application