Emergency Housing Rental Assistance Application
Submit your application and upload required documents;We will respond within 7–14 business days.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
0
01
011
0111
01111
Year
Do you have any children in the home?
Yes
No
How many
Names, Ages, Date of Birth
Do you live in Davidson county?
*
Yes
No
Type of Assistance Requested
*
Rental Assistance
Deposit Assistance
Utility Assistance
Childcare Assistance
Water Bill Assistance
Emergency Hotel
Requested Amount (USD)
*
Upload Government-issued Photo ID
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Social Security Card
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Proof of Income
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Lease Agreement or Approval Letter
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Bill (if applying for utility, water, or childcare assistance)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Proof of Eviction or Homelessness
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Proof of childcare assistance letter and payment from childcare provider
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Utility Account Number (if applying for utility or water bill assistance)
Landlord's Full Name
Landlord's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Landlord's Email Address
example@example.com
Additional Comments or Special Circumstances
Submit Application
Should be Empty: