WATCH CDC Intake Form

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This form is for Waltham residents ONLY

Non-Waltham Residents
You have indicated that you are not a Waltham Resident. Please visit https://www.masshousinginfo.org/. You will be able to find the agency that is best suited to assist you based on your city of residence.
Client and Household Information
An email or phone number are required to fill out this form. If you do not have either of these, please call Suzi for assistance (781) 570-4394An email or phone number are required to fill out this form. If you do not have either of these, please call Suzi for assistance (781) 570-4394
Please note that this application can be saved and finished later


Please enter the name on your ID

Please enter the name on your ID

Please put complete street address and apartment or unit number






For example: 123-456-7890


i.e. 01/05/1974







Enter your income with no dollar sign, commas, or decimals














Over the last 2 weeks, how often have you been bothered by the following problems related to housing or financial difficulties?


Housing Information




Enter amount with no dollar sign, commas, or decimals

Enter amount with no dollar sign, commas, or decimals



Housing Problems



Behind on Rent

Enter a number with no dollar sign, commas, or decimals



Landlord Information
In order to best help you, we many need to contact your landlord to explain the rental assistance programs.  








i.e. 000-000-0000

Housing Search / Moving




Public Housing
Public housing often has long waiting lists, but is worth applying for if you are eligible and do not anticipate being able to afford regular housing in the long term.
















Household Finances
In order to match you with available resources, please share information about your financial situation.  





Enter a number with no dollar sign, commas, or decimals



Job Help





Financial Management Help




Voter Registration

Documents
Please upload your ID in order to be considered for our Back to Work Grant or WATCH Tenant Assistance Fund.