CHN Housing Partners Online Rental Assistance Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1

Please use the page numbers above to navigate to specific areas of the form

Welcome to CHN Housing Partners Online Application for Rental Assistance

How does it work?
This lifeline, funded by the City of Cleveland and Cuyahoga County, is for residents who are facing financial hardships due to COVID-19 and need help paying rent. Income restrictions apply.

Income Limits (vary by program) 

80% Area Median Income 

120% Area Median Income 

Household Size 













































CHN is the entry point to access rental assistance, a broad array of housing, utility assistance, and referral resources, which you will be screened for. You will be under no obligation to participate in any programs we recommend. 

Fill out the online application in its entirety and upload all documents requested for expedited processing. Please review this Document Checklist before you start to ensure you are prepared to submit a complete application when you begin.

For your convenience, CHN Housing Partners allows the use of e-signatures with this online form. You will be prompted to enter your name at the end of this form prior to submitting to give consent. If you would rather fill out and return a physical copy of this package, you can obtain one HERE.

Still need help? Call our hotline at 833-377-RENT.

Who qualifies?
Residents of the City of Cleveland and Cuyahoga County who are having difficulty making rental payments due to the economic impact of the pandemic and who meet income eligibility requirements. Priority is given based on criteria such as eviction status, accurate information and complete documentation. If you qualify for rental assistance, you may be required to attend more in-depth financial counseling, provided by CHN, as a condition for payment of the rental assistance. 

Note: We can provide up to 3 months of rental assistance, paid directly to your landlord. If you need help after 3 months, we will connect you with our partner EDEN, Inc. who can provide longer term financial help.

Online Application Guidelines
To apply for programs with CHN Housing Partners, you must complete an application with us along with providing documents to verify the information submitted. We have split this into the following sections:

1. Application information: Your contact and demographic information
2. Household members: Other members of your household and their demographic information
3. Income sources: All verified sources of income and public benefits for all household members over 18
4. Assets: All liquid assets for all household members over 18
5. Housing & utility details: Details about your rent/mortgage and utilities for program-specific purposes and to help us assess what program(s) you may need
6. Document upload: We will request scanned copies, legible photos or screenshots of documents as verification for your eligibility for programs. Please review our Document Checklist prior to starting this form and have the requested documents prepared.

You may encounter a slow system or downtime due to a high volume of traffic on the site. Please use the "Save my progress and resume later" feature located at the top of the form OFTEN to avoid losing any information. (This form is powered by FormAssembly.)

Fair Housing Act (42 USC 3600, et seq.)
If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)

Click Next Page to Continue

Page 2

Please use the page numbers above to navigate to specific areas of the form

Applicant and Co-Applicant Details

In this section, please enter your most up to date contact information and demographic information.

CHN Housing Partners (CHN) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared verbally and/or in writing will be managed within ethical and legal consideration. Additionally, we want you to understand how we use the personal information we collect. Please carefully review this notice as it describes our policy regarding the collection and disclosure of your nonpublic, personal information.
CHN's Privacy Policy

The Applicant (and Co-Applicant, if applicable) should be an adult member of your household that will be able to represent, provide information for, and make decisions on behalf of your household. 

Please prepare for upload: Photo Identification and Social Security Cards for each Applicant and Co-Applicant.
Applicant Information

Enter date in MM/DD/YYYY format

Please select the Agency that helped you complete this Application or made you aware of it

Co-Applicant Information

Enter date in MM/DD/YYYY format

Need help? Call our hotline at 833-377-RENT.

Page 3

Please use the page numbers above to navigate to specific areas of the form

Household Members

Please enter additional members who reside in your household (i.e. children, dependents, other family members, etc.). Use the "Add Additional Household Member" link to add as many as you need.

You do not need to re-enter Applicant or Co-applicant (if applicable) information here.

Please prepare for upload: For each household member, be prepared to provide verification that they are your dependents - such as Social Security Cards and Birth certificates

Household Member

Enter date in MM/DD/YYYY format

Need help? Call our hotline at 833-377-RENT.

Page 4

Please use the page numbers above to navigate to specific areas of the form

Income & Public Benefit Sources

Please enter all sources of Income and Public Benefits that your household receives, for all household members over the age of 18. Use the "Add Additional Source" link to add as many as you need

Income includesFull-time employment, part-time employment, self-employment, spousal support, child support, investment income, Social security, SSI, SSDI, income from assets, pension/annuity, unemployment, adoption subsidy, short term disability, long term disability, veteran's benefits, zero income, family contribution, other

Public benefits include
Food stamps, WIC, ADC, OWF/TANF, rental subsidy, utility allowance, other public benefit

Please prepare for upload: Verification of income for the past 30 days - pay stubs, employment letters, award letters, etc. You may also use this Self Certification of Income Form in lieu of Income Documents.

If you answered "No", you must fill out and upload the CARES Act Self-Certification of Income form
Income or Public Benefit Source

Enter the Household Member who this income belongs to

Provide the Job Title for Employment types, if applicable

Please estimate to the best of your ability. Our staff will review your documents and provide a full eligibility determination.
Need help? Call our hotline at 833-377-RENT.

Page 5

Please use the page numbers above to navigate to specific areas of the form

Assets Declaration
Please enter all liquid Assets you have control over for all household members over the age of 18. Liquid assets are cash on hand or assets in any other form that can be converted to cash within 20 days (

Asset types include: Bank Accounts - Savings and/or Checking, Investment Accounts, Retirement, Certificates of Deposit, Cash on Hand, Pre-paid Debit Cards, Health Savings Accounts, Life Insurance Cash Value


Please estimate to the best of your ability - enter 0 if unsure
Need help? Call our hotline at 833-377-RENT.

Page 6

Please use the page numbers above to navigate to specific areas of the form

Household and Utility details

We will be asking more specific questions about your Housing Details here, including your living situation, rent amount, and utility details. This information will allow for us to screen eligibility for the wide range of programs we offer. You will be under no obligation to participate in programs we recommend.

Please prepared for upload: Lease Agreement, copies of utility bills for all utilities and additional verification as requested in each section that follows

You will be asked to provide a copy of your Lease Agreement. If your Lease Agreement is verbal, please use this Lease Template to outline the terms of your lease with your landlord.

Landlord questions

By providing your property owner's information, you authorize us to contact them to discuss your housing situation.


Please provide information for all utilities you are responsible to pay for, even if your name is not on the bill. We will be able to assess your ability to receive assistance payments and/or discount programs that we administer.




Hardship Statement

We require a statement of Hardship that helps explain why you need assistance. Please select the category that represents the primary hardship reason and any additional detail in the Hardship Statement. If your income was lost due to Layoff or Furlough, please provide the Lost Income details below.

You will be required to provide verification that substantiates your hardship.

up to 255 characters
Lost Income Source

Please estimate what your Annual Income was prior to job loss
Need help? Call our hotline at 833-377-RENT.

Page 7

Please use the page numbers above to navigate to specific areas of the form

Upload Documents

Please use this page to upload documents that support your application. You can attach electronically downloaded documents (like paystubs), use a scanner, or take pictures of your documents with your phone.

You can upload multiple files per section by using the "Add another ..." link. There is a limitation of 20 files per form. If you have more than 20 files to upload, please email them to

Have questions about what documents you need per section? Review the Document Checklist.

Complete applications with all required supporting documents will be processed faster - please upload as much as you are able to and ensure you have documents for each section!  

If taking photos with your phone/camera, you can line up your IDs and Social Security cards within one image, instead of one at a time

Upload pay stubs, benefit statements and other income verification documents here that cover the past 30 days for your household.

Lease Agreement

Upload a copy of your current Lease Agreement or Lease Template

Utility Bills
Upload Utility Bills in each section listed here based on programs you are requesting assistance for.

Hardship Verification

Upload documents that substantiate your hardship, such as pay stubs reflecting a reduction in hours or pay, termination letter, increases in expenses, medical bills, etc. Verification is required for COVID relief funds.

Need help? Call our hotline at 833-377-RENT.

Page 8

Please use the page numbers above to navigate to specific areas of the form

Acknowledgement & Submit

I/we certify that all provided information is correct to the best of my knowledge and have received a copy of CHN's Privacy Policy. I/we authorize CHN Housing Partners to verify all information contained on this online form and to pull my credit report. I/we understand that I may be assisted by federal funds which carry severe penalties, including incarceration.

Applications for CARES Act Funding:
I/we certify that I/we have been adversely impacted by the Coronavirus and I/we are seeking this assistance to address or mitigate an unmet need

I/we certify that this assistance is meeting an unmet need that is not duplicated assistance from multiple sources for the same coronavirus response purpose, and the total assistance received for that purpose is not more than the total need.

I/we certify that this information is correct and accurate. I/we agree to provide, upon request, documentation on all income sources to the HUD Grantee/Program Administrator.

By typing my full name below, I hereby authorize CHN to release nonpublic personal information it obtains about me to any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices. I understand I will receive a copy of all information submitted at the email address I provided on Page 2, "Applicant E-mail Address".

WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.