Short-Term Rental Assistance Application

Short-Term Rental Assistance Application

Puede traducir este formulario con la bandera de idiomas en la esquina derecho
Please Note: We need the following items to process your application whether you are COVID-impacted or not.

You can upload them below or email copies to us at rentassist@neighborimpact.org
- 30 days proof of all types of income for all persons 18 or over in household:
  Types of Income - Unemployment printout, paystubs, current SSI award letter, TANF Verification of Benefits, Child Support, Alimony, etc.
- If you are self-employed, we can use your bank statement and/or screenshots of payment apps for the last 30 days or you can complete a worksheet
- If you do not have any income, you can still apply! We will send you a Zero Income document
Once we determine if we can help you, we will need you to gather some other things:
- For COVID Rent Relief, you can find the list here .
- For regular Short-Term Rental Assistance, you can find the list here .
Use the Browse Files button below to attach and upload all applicable documents listed above.
Cancel of
Email - *This is the only way you will receive notice of application status
example@example.com
Important: All sections must be completed in order to be considered for Rental Assistance. A completed application is not a guarantee of assistance.
Date *

Month Day Year
Date
Name *

First Name Last Name
Applicant Phone Number *
Unit Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landlord name

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

Requesting:

Eviction Prevention Move-in Assistance*
*NeighborImpact is not able to help with housing search for short-term assistance
Do you have a notice to vacate?

Yes No
72 Hour Eviction Summons
Monthly Rent Amount:
Have you been approved?

Yes No
Deposit Amount:

Rental Assistance Action Plan
I can’t pay my rent or deposit right now because…
If I get help from NeighborImpact, I could…
This is what I will do to make sure I don’t need help again…
Should be Empty:

Short-Term Rental Assistance Application

Household Information

Rental Assistance Action Plan