Rent Assistance Pre-Screen Survey 2023

Name(Required)
Email(Required)
Are you a renter with a Larimer County lease?(Required)
Have you received rental assistance from Neighbor to Neighbor in the past 12 months?(Required)
Does your rental household earn less than 60% of the AMI?(Required)
Please review the Area Median Income information below. If your household income is higher than the amount listed next to the number of people in your household, your response is “No.” If your income is less than that amount, your response is “Yes.” (# of people in household): 60% AMI amount 1: $45,120 | 2: $51,480 | 3: $57,960 | 4: $64,380 | 5: $69,540 | 6: $74,700 |
Has a household member lost employment in the last 60 days OR does your rental household earn at least 1.5 times your monthly base rent? For example, if rent is $1,000 per month, your household monthly income meets or exceeds $1,500.(Required)
Do you currently have documentation of an eviction notice, a demand for compliance or a set court date from your landlord?(Required)
This must be a legal document, not an email or a text message.
Do you currently have third-party documentation that can verify your need for assistance is unforeseen and out of your control?(Required)
Confirm Information(Required)
This field is for validation purposes and should be left unchanged.