COVID-19 RENTAL RELIEF APPLICATION

Applicant Contact Information (Must Be Named on Rental Agreement)









Household Information




Financial Assistance Information
Assistance cannot be applied towards taxes, fees, or deposits.







Household Monthly NET Income


Please report income amounts below for the ENTIRE HOUSEHOLD.

All income must be DOCUMENTED.

Provide
AFTER-TAX or NET amounts. 

If you have no income in a category, please type 0. Round to nearest dollar.








Household Monthly Expenses
Please report expense amounts for the ENTIRE HOUSEHOLD.

I
f you have no expenses in a category, please type 0. Round to nearest dollar.
Household Housing Expenses






Household Transportation Expenses



Other Household Expenses








By clicking Submit, I attest that:
  • I live at and am responsible for the rent to which this funding will be applied.

  • I am the head of household/lessee.

  • My household has not/will not receive any other CARES rent assistance from a Montgomery County agency between 1/27/2020 and 5/31/2021.

  • I have provided complete and accurate household financial information.

  • I have provided complete and accurate contact information for my landlord.

  • I will provide all required supporting household documentation (copy of rental agreement/lease; income, bank, utility, loan documents; proof of childcare expense; etc).