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Emergency Rent Assistance Program
Emergency Rent Assistance Program
Neighbor2Neighbor
2023-02-03T15:12:05-07:00
Rent Assistance Pre-Screen - New Applicants
First Name
(Required)
Last Name
(Required)
Email Address
(Required)
Phone Number
(Required)
Are you a renter with a Larimer County lease?
(Required)
Yes
No
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 |
Yes
No
Do you currently have documentation of an eviction notice or demand for compliance from your landlord?
(Required)
This must be a legal document, not an email or a text message.
Yes
No
Can you provide third party documentation to verify your need for assistance is unforeseen and out of your control?
(Required)
Yes
No
Confirm Information
(Required)
I attest that the information I have provided today true and accurate. If requested, I agree to provide all documentation that I have confirmed in this form. While this survey does not guarantee or determine funding, any inaccurate information that I have provided at this time will impact determination of my eligibility now and in the future.
I confirm this information.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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