Short-Term Rental Assistance Application

Short-Term Rental Assistance Application

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Rental Assistance applications are prioritized based on need and an application to our program does NOT guarantee assistance. We are only able to support those living in Deschutes, Jefferson and Crook county, as well as those living on the Warm Springs Reservation.

(Updated June 2023)

Rental Assistance Funding is only currently available for household with:
- A housing choice voucher holder that has been approved for housing & needs deposit assistance
- An active eviction case
- A pending first court appearance
- An eviction court summons
- A written 10-day notice to vacate
Have the following documents READY to be uploaded; applications without these documents will be denied.

For all adults 18 and over:
- 60 days proof of income
- Copy/picture of ID (can be from another state/country)
- 60 days bank statements (just monthly ending balances)
- Rental agreement (Make sure your rent amount is current)
- Written copy of past due balance from landlord
- Copy of move-in paperwork if requesting deposit assistance
Email - *This is the only way you will receive notice of application status
example@example.com
Date*

MonthDayYear
Date
Name*

First NameLast Name
What are your pronouns?

She/herHe/himThey/themI prefer not to sayOther
Your Phone Number*
Your Address (Deschutes, Jefferson, Crook County & Warm Spring Reservation Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Important: All sections must be completed in order to be considered for Rental Assistance. A completed application is not a guarantee of assistance.
Landlord Information

If you don't have a landlord right now you can skip this page
Landlord Name

First NameLast Name
Landlord Phone Number
Landlord Email Address
example@example.com

Please choose what best fits your current situation:*

Loss of job/income because of COVID-19Loss of job/income in the last 6 months not because of COVID-19Income GarnishmentRecent medical event resulting in loss of incomeChange in household members (someone with income left, new child in home, etc.)Recent unexpected bill (large utility bill, car repair, medical bill, etc.)Other
Is there anything else about your situation you want us to know?

Upload as many of the following documents as you can to make sure your application is complete.

For all adults 18 and over:
- 60 days proof of income
- Copy/picture of ID (can be from another state/country)
- 60 days bank statements (just monthly ending balances)
- Rental agreement
  - Make sure your rent amount is current
- Written copy of past due balance from landlord
- Copy of move-in paperwork if requesting deposit assistance
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Are there other NeighborImpact programs that you're interested in learning more about? We may be able to refer you!

Energy AssistanceWeatherizationHead Start/Early Head StartChild Care ResourcesHomeSource/Financial Counseling
Would you be willing to work with us to share your experience in receiving assistance? NeighborImpact will never release any of your personal information without your permission.*

Yes, absolutelyYes, but prefer to remain anonymousMaybe, I'd like more infoNo, thanks

If you don't want us to yet, that is okay, but we will need to contact them upon approval of services. By initialling this form, you are giving NeighborImpact permission to speak with your landlord about your situation and payment.
If NeighborImpact has permission to speak with your landlord, type initials here:
Applicant Signature*

Clear
Should be Empty:

Short-Term Rental Assistance Application

Landlord Information

Household Information