San Leandro                                                         Covid Rental Assistance Application

Are you Eligible?


Applicants must be:


  • A current resident of incorporated San Leandro

  • Experienced a hardship due to Covid-19

  • At risk of losing their home

  • A low-income individual or household



After You Apply


Funding is extremely limited, and applications will be prioritized based on need, severity of COVID-19 impact, and funding availability. If your application is selected for assistance, you will be asked to provide documentation to verify eligibility, including but not limited to:


  • Government Issued Photo ID

  • Current lease agreement or proof of tenancy

  • Documentation of substantial decrease of household income or increase in costs due to Covid-



     If you are unable to fill out this application form, please call us at 510-422-5669
Si tiene dificultad en llenar la solicitud, por favor llámenos al número 510-422-5669

Personal



Address




Phone & Email





Demographics








Household Members & Income
Do not repeat applicant's information here
Household members list

Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy


Enter first and last name

mm/dd/yyyy



Hardships due to Covid-19


Rent Due Before & After to Covid-19 Shelter-in-place
Complete the statements to best represent your situation:


Rent Information



Currently owed to the landlord
Rent Due Rent Paid 
March (after 3/16/20)
April 2020
May 2020
June 2020
July 2020
August 2020
September 2020

Relationship to landlord

Landlord information








Optional questions - For informational purposes only













Required Documentation
Tenant
  1. Government Issued Photo ID.
  2. Current residential lease agreement or proof of tenancy.
  3. Documentation of substantial decrease of household income, including but not limited to a termination notice, payroll check or pay stubs, bank statements, medical bills, unemployment award letter, signed letter from employer explaining tenant’(s) changed financial circumstances or self-certification of tenant’s inability to pay the next month’s rent.
Landlord (NOTE: the applicant does not have to provide their landlord's documentation, but it will be needed in order to process your rental assistance grant payment.)
  1. Copy of a current City of San Leandro business license or proof of application for said license.
  2. Signed and completed W-9
  3. Signed affidavit affirming that the landlord has not and will not receive payment for the same month(s) rent due for the same tenant from any other rental or mortgage assistance program.
Upload document

[To add multiple documents, please click on the link above] 
Consent/Disclaimer
I authorize Centro Legal de la Raza to release the information contained in this application to any funder of this program in order to verify my eligibility for the program. This may also include any other agency or property management company/property owner who could be helpful in understanding my situation. Upon approval of my application I further authorize the release and sharing of information between Centro, the funding agency, and the landlord. I understand information shared will be necessary and appropriate for administering the financial assistance program provided and for coordinating and verifying services on my behalf. I understand that information that I share will remain confidential, and will only be used for the purposes described above. I hereby affirm that the information provided my application is true and complete to the best of my knowledge. I understand that if I provide any false information or misrepresentation during the application process that it will be grounds for denying my application to the Program. I understand in submitting this application I am not guaranteed financial assistance from the Program. In addition, my signature below acknowledges my understanding and consent to the release of information as described above. I understand that I have the right to revoke this consent in writing at any time, except for information already released, and that unless I decide to revoke it sooner, this consent will terminate two years after receipt of assistance from the program. If my application is selected for processing, I agree to provide tenancy information to a representative of Centro through means such as text messages, phone, or email for the purposes of evaluation. I understand that in order for Centro to continuously improve its services and understand the effectiveness of the Program, they may follow up after services have been provided.

Your signature below states that you recognize that electronic communications (text message) are not secure; you hereby authorize Centro to communicate with you regarding services received from the Program using electronic communications as indicated below and have provided the phone number above to text message, Additionally, you understand that text messaging is to be used to the purposes of communicating on a limited basis and text messages are not intended to provide additional support. If you are in need of additional support when you receive a text message, you understand that you should not text your concerns; rather, you should contact Centro via phone. You understand that you can end (“revoke”) this waiver at any time during service.

I declare under penalty of perjury that the information provided in this application is true and accurate to the best of my knowledge. I understand that willfully and knowingly making a false or fraudulent statement on this application is a felony that may be punishable by jail time and/or a fine.  I also understand that the information provided on this form is subject to verification by Centro Legal de la Raza, the City of San Leandro, and the United States Department of Housing and Urban Development at any time.


If you are unable to fill out this application form, please call us at  510-422-5669
Si tiene dificultad en llenar la solicitud, por favor llámenos al número 510-422-5669