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Emergency Rent Assistance Program
Emergency Rent Assistance Program
Neighbor2Neighbor
2023-05-19T10:54:27-06:00
Rent Assistance Pre-Screen Survey 2023
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone Number
(Required)
Are you a renter with a Larimer County lease?
(Required)
Yes
No
Have you received rental assistance from Neighbor to Neighbor in the past 12 months?
(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
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)
Yes
No
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.
Yes
No
Do you currently have third-party documentation that can 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. I agree to provide all documentation that I have confirmed in this form. While this survey does not guarantee or determine assistance, any inaccurate information that I have provided at this time, as well as any duplicate submissions of this survey, will impact determination of my eligibility now and in the future.
I confirm this information.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
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