Si necesita este formulario en español, haga clic aquí.

Have you received rental assistance previously?

How many months?

Do you live in Howard County?

Is your name on the lease?

Do you currently owe money for rent or utilities and have documentation proving this?

Were you financially impacted by COVID?

Is the housing assistance that you require for rent or for a mortgage?

Primary Language

Unfortunately, we are unable to offer you financial assistance at this time. Please visit our website firnonline.org for information on other assistance services we provide.

If the housing assistance that you require is for a mortgage, please contact the Community Action Council of Howard County at 410-313-6440.

Thank you

First Name

Last Name

Country

Street

City

State

Zip/Postal Code

Mobile Phone

Email

Family Size

Monthly Household Income - Pre COVID

Monthly Household Income - During COVID

Income Notes

Hispanic

Female Head of Household

Is anyone in the household a Veteran?

Is anyone in the household age 55 or older?

Are you or were you ever homeless?

Is anyone in the household disabled?

Is the head of household a single parent?

Are you currently employed?

Name of former employer

Were you out of work due to COVID?

Number of months out of work due to coronavirus

How has COVID-19 affected your income/employment?

Have you received a eviction notice?

Eviction Date

Have you received a court notice?

Court Date

What type of assistance do you need?

Rental Assistance

Cost of monthly rent

Months Rent Owed

Rent Balance Owed

Months Rent Requested

Rent Balance Requested

Name of Rental Agency

Rental Agency phone number

Rental Agency Address

Other Information

Utility Assistance

Months Utility Bill Owed

Utility Bill Balance owed

Months Utility Bill Requested

Utility Bill Balance Requested

Shut-Off Date

Utility Company Name

Utility Company Address

Do you have an additional utility bill owed?

Utility Assistance 2

Months Utility Bill Owed

Utility Bill Balance owed

Months Utility Bill Requested

Utility Bill Balance Requested

Shut-Off Date

Utility Company Name

Utility Company Address

A copy of the household's valid current lease, or documentation of the month to month tenancy arraignment signed by the landlord.

An ID that matches the address on the lease.

Proof of amount owed from the rental agency/landlord.

Utility Bill

File Upload

I certify the above information is accurate.

I have enclosed proof that I am a Howard County resident, experiences COVID-19 related income loss, and rent owed.

I understand that due to the number of applicants there is no guarantee that I will be approved for assistance.

I understand that this is not emergency assistance and the process can take up to 6 weeks. I understand that reaching out to ask the status can delay the process and I will receive an email once decisions are made.

By typing my name below, I am electronically signing this application.