Emergency Rental Assistance Program

At HOUSE, Inc., we understand that unexpected financial hardships can make it difficult to keep up with rent payments. Our Emergency Rental Assistance Program provides temporary relief to families facing housing insecurity due to unforeseen circumstances, such as medical emergencies, job loss, or other crises. We offer financial support in the form of 0% interest forgivable loans, with no obligation to repay. However, if you are ever in a position to contribute back, it would help us continue assisting others in need. Our mission is to prevent homelessness and offer a pathway to stability with compassion and dignity.

Please complete the application below to see if you qualify for assistance.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you a Veteran?

Yes

Rental Information

Please provide information about your current rental or housing situation: Landlord Name: Landlord Contact Information (Phone/Email): Property Address: Monthly Rent Amount: Due Date of Rent: How many months behind on rent are you? Do you have a lease agreement?

Financial Information

Briefly explain the reason(s) for needing rental assistance: (e.g., job loss, medical emergency, unexpected expenses) Gross Monthly Income (for all adults in the household): $ Source(s) of Income: (e.g., employment, social security) Do you receive any government assistance? If yes, please specify the program(s) and amount(s) received. List of monthly expenses: (rent, utilities, groceries, transportation, etc.)

Additional Information

Is there any other information you would like to share with HOUSE, Inc. regarding your situation?