The Cherokee County Emergency Rental Assistance funds are made available for Cherokee County residents ONLY. To qualify, you must have experienced a financial hardship on or after March 16, 2020.

Funds may be used for the following:

Rent/rent arrears (single family homes, condominiums, attached homes or apartments)
Utilities and home energy costs
Hotel/Motel assistance
Security deposit and rental payments

Payments are available for up to 18 months of assistance. However, if the tenant has received rental assistance previously through the Cherokee ERA program, those payments will reduce the number of months allowed under this program. All payments will be made to landlords or utility providers (not directly to tenants). Service Provider must receive documentation within 7 days of applying.

If not, your application will be closed, and you will need to contact the service provider for your application to be reopened.

The following documentation is required for financial assistance (i.e. ALL documents must be included for processing):

Applicant’s Photo ID – a copy of either your license, state-issued ID, or government-issued ID
Social Security number for all members of the household. If household members do not have a Social Security number, they may provide their Passport or Consulate ID number
Proof of employment income (gross-pre-tax) for the previous 2 months for each household member 18 and older which includes wage/salaries, overtime pay, commissions, fees, tips/bonuses, and other compensation OR a copy of the 2020/2021 Form 1040 filed with the IRS for the household
Proof of unearned income for each household member including unemployment, social security, child support, SSI, retirement, worker’s compensation, TANF

Do you have all required documents in your immediate possession?

YesNo

Please STOP and collect all documentation before continuing.

Application will not be considered until all information has been received. Funding is based on availability.

Are you a Cherokee County renter?

YesNo

Did you experience a loss of income on or after March 16, 2020?

YesNo

Why did you experience a loss of income? Check all that apply.

Laid offReduced HoursReduced PayOther

Please enter the 'other' loss of income.

Have you received a summons to appear in court for an eviction proceeding?

YesNo

What is the date you are scheduled to appear?

Have you previously received rental assistance in Cherokee County?

YesNo

With which service provider?

What is the total amount of prior assistance?

How much assistance are you now requesting? ($)

Do you meet the income requirements listed below?

YesNo

Are you utilizing any other rental subsidy (e.g. Housing Choice Voucher, Family Unification Voucher, VASH, Mainstream Voucher, Project-Based Section 8, Public Housing, HOME Tenant Based Rental Assistance, Continuum of Care, etc.)?

YesNo

If you are utilizing another rental subsidy, which one?

Based on the initial screening, we determined this household is ineligible for assistance.

Your application will not be reviewed.

Please attest to the following: I give my permission, and for any minors for whom I am legally responsible, for the Service Provider to:

Verify financial information from Federal, State, Public, or Private agencies in connection to this request/provision of human services

Agencies to be contacted

Seek information from present or former employers

Employers to be contacted

Seek information from my present or former apartment complex, landlord, or mortgage holder regarding my financial or occupancy status

Name of Property Manager/Owner/Agent to be contacted

(Type N/A if this is not applicable or does not apply)

Seek information from my present or former utility vendors regarding my account

Utility vendor(s) to be contacted

(Type N/A if this is not applicable or does not apply)

Verify other information deemed necessary as described below

(Type N/A if this is not applicable or does not apply)

Service Provider has my consent to access and disclose personal information collected in connection with the processing of any request by me for human services, the provision of any such services on behalf of myself or any minor for whom I am legally responsible, to determine client needs, raise adequate support to meet the needs which I have presented, and/or for any related administrative activities. A copy of the Service Provider’s Privacy and Security Policies are available by clicking this link.

This information shall be kept strictly confidential. This permission will remain in effect for four (4) years from the date of signature. I also understand that I can revoke it in writing at any time without penalty.

Do you agree to these terms?

YesNo

Signature

Enter your name

Date Signed

Warning: You are withdrawing your consent for the activities listed. This will cause your application to be removed from consideration and automatically denied.

Signature

Enter your name

Date Signed

Head of Household Details:

First Name

Middle Name

Last Name

Social Security, Passport, or Consulate ID number (#)

Birthdate (MM/DD/YYYY)

The Head of Household must be 18 years of age or older

Mobile # :

Email Address:

Has anyone in the household (age 18 and older) been unemployed for more than 90 days?

Yes

No

Head of Household Income

IMPORTANT: Please list the monthly gross (pre-tax) employment income for the head of household.

What is the most recent date of employment?


Employer Income
Self-Employment
Unemployment
SSI
SSDI
Veteran’s Disability
Private Disability
Worker’s Comp
TANF
General Assistance
Retirement
Veteran’s Pension
Other Pension
Child Support
Other Income

Head of Household Income

DO YOU HAVE ADDITIONAL HOUSEHOLD MEMBERS?

Yes

No

You must select 'YES' if others live in the household for which you are seeking assistance

Add Household Members

Please list the information of each additional person in your household (ALL children and adults)

First Name

Middle Name

Last Name

Social Security # Or Passport Consulate ID #

Birthdate (MM/DD/YYYY)

Is this person age 18 or older?

YesNo

Mobile # :

Email Address:

Relation to Head of Household

Race

Ethnicity

Disabled?

Yes

No

Veteran?

YesNo

Homeless

Yes

No

Gender?

Male

Female

Chose Not to Self-Identify

Other Household Income

Please list the monthly gross (pre-tax) employment income for each household member 18 and older.

What is the most recent date of employment?


Employer Income
Self-Employment
Unemployment
SSI
SSDI
Veteran’s Disability
Private Disability
Worker’s Comp
TANF
General Assistance
Retirement
Veteran’s Pension
Other Pension
Child Support
Other Income

Individual Income

Total number of members in household

Total Household Income

Please review the income limits again and verify the 'Individual Income' or 'Total Household Income' is not greater than the 'Maximum Monthly Income' based on the number (#) of people in the Household.

Your application will be denied if you exceed this maximum.

Please attest to the following statements:

1. I hereby certify that my household does not receive income from any of the following sources:

a. Wages from employment (including commissions, tips, bonuses, fees, etc.).

b. Income from operation of a business.

c. Rental income from real or personal property.

d. Interest or dividends from assets.

e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits.

f. Unemployment or disability payments.

g. Public assistance payments.

h. Periodic allowances such as alimony, child support, or gifts received from persons not living in my household.

i. Sales from self-employed resources (Avon, Mary Kay, eBay, etc.).

j. Any other source not named above.

2. My household currently has no income of any kind and there is no imminent change expected in my financial status or employment status.

I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud.

Applicant/Head of Household Signature :

Enter your name

Date Signed :

Additional Adult Household Member (if applicable)

Enter your name

Date Signed :

Please provide the following to certify your self-employment income

Name of Business

Type of Business

Position / Occupation

EIN / Tax ID Number (#)

Employer Identification Number / Federal Tax ID

Past Net Monthly Income (average 3 months prior to COVID-19)

Reduction of Net Monthly Income due to COVID-19

Please note: You are required to attach 3 months of supporting bank statements.

Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud.

Applicant/Head of Household Signature

Enter your name

Date Signed

Additional Adult Household Member (if applicable)

Enter your name

Date Signed

Household Information

Home Street :

Apartment/Unit Number:

City :

State :

Zip :

Rent Information

What is your monthly payment?

Utilities Information

Gas Information

What is your monthly gas payment?

Is your gas late (in arrears)?

YesNo

Name of the Utility company

Account Number

Which month is late?	Year?	Past Due Amount?
Late Fees (if any)?

Total Late Fees Assessed

Total Gas Due

Total Gas Due (including fees)

Electric Information

What is your monthly electric payment?

Is your electric late (in arrears)?

YesNo

Name of the Utility company

Account Number

Which month is late?	Year?	Past Due Amount?
Late Fees (if any)?

Total Late Fees Assessed

Total Electric Due

Total Electric Due (including fees)

Water Information

What is your monthly water payment?

Is your water late (in arrears)?

YesNo

Name of the Utility company

Account Number

Which month is late?	Year?	Past Due Amount?
Late Fees (if any)?

Total Late Fees Assessed

Total Water Due

Total Water Due (including fees)

Total Past Due Utilities

Total Past Due Utilities (plus fees)

The Cherokee County COVID Rental Assistance Program will remit rent payments on behalf of approved program recipients directly to the recipient’s landlord or property owner. A complete application for rental assistance includes paperwork that must be completed and submitted by the applicant’s landlord or property owner. In signing this consent form, I am authorizing the program provider to contact my landlord and/or property owner to request information, including but not limited to, rent and payment information and I hereby authorize my landlord to release such information. I also authorize the provider to release my information to my landlord which is deemed necessary to complete my application and receive assistance. I authorize my information to be transmitted via any method, including U.S. Postal Service, fax, and email.

Landlord Information

Landlord Name/Apartment Complex

Address

This is the landlord's address so might not match your physical address

City

This is the landlord's city so might not match your city

County

This is the landlord's county so might not match your county

State

This is the landlord's state so might not match your state

Zip Code

This is the landlord's postal code so might not match your zip code

Is this property a hotel/motel?

YesNo

Please note: Assistance will only be provided for temporary lodging payments in the future. Past due bills will not be paid.

Property Manager

Landlord/Property Manager/Owner Contact Name :

Landlord/Property Manager/Owner Phone Number:

Enter a phone number with dashes only

Landlord/Property Manager/Owner Email Address :

In signing this consent form, I further authorize the provider of this program to disclose information about my application and program recipient status to program funders, as deemed necessary, to comply with grant requirements. I understand that my authorization will remain effective from the date of my signature through the duration of my participation in the program, and that the information will be handled confidentially in compliance with all applicable state and federal laws. I understand that I may revoke the authorization at any time by written and dated communication.

I have read and understand by signing below, I certify that I am giving permission for the provider to obtain or share information for emergency rent assistance.

Applicant/Head of Household Signature :

Enter your name

Date Signed :

Additional Adult Household Member (if applicable)

Enter your name

Date Signed :

Please upload the following documents. Your application for financial assistance will not be accepted without all documentation. Please save your application and return later if you do not have all documents, including documents for each member of the household.

Applicant's Photo ID

This may include a copy of either your license, state-issued ID, or government-issued ID

Social Security Card (ALL Household Members)

Social Security cards for ALL members of the household. If household members do not have a Social Security number, they may provide their Passport or Consulate ID number

Employer Income (all Household Members 18 and older)

Gross-pre-tax Proof of employment income for the previous 2 months for each household member 18 and older which includes wage/salaries, overtime pay, commissions, fees, tips/bonuses, and other compensation OR a copy of the 2020 Form 1040 filed with the IRS for the household

Self-Employment Income (all Household Members 18 and older)

Gross-pre-tax proof of self-employment income for the previous 2 months for each household member 18 and older OR a copy of the 2020 tax form filed with the IRS for the household

Unearned income (ALL Household Members)

Proof of unearned income for each household member including unemployment, social security, child support, SSI, retirement, worker’s compensation, TANF

Proof of Residence

Proof of Residence (Current Lease) - the applicant’s full name must be on the lease; signature page must be provided.

Current Tenant Ledger or Account Statement

Proof of Hardship (view help)

LIST A - ACCEPTABLE COVID HARDSHIP DOCUMENTS – ALL REQUIRE APPLICANT NAME & DATE • Unemployment Benefit Determination (after 3/13/2020) • Unemployment Benefit statement dated within 30 days of signed application • Pandemic Unemployment Assistance (PUA) Notice (start date after 3/13/2020) • Pandemic Emergency Unemployment Compensation (PEUC) Notice (start date after 3/13/2020) • Separation Notice after 3/13/20 (lack of work due to COVID) • Furlough letter referencing COVID • Employer layoff/termination letter referencing COVID • Employer letter of lost wages or hour reduction due to COVID • COVID Emergency Family Medical Leave determination • Medical notice of COVID risk due to underlying condition that impacts your ability to work • Childcare closure/virtual school notice for current semester ALONG WITH an employer letter of hour reduction, separation, or termination due to childcare • Bank Statements (for self-employed applicants ONLY) that demonstrate income prior to AND after COVID; must also include a written explanation of how statements demonstrate COVID related impact to income

Current and/or Past Due Rent and/or Utility Bill

8. Current and/or Past Due Rent and/or Utility Bill (if requesting support for utilities) – name and address on utility bill/statement must match the name and address of applicant

Thanks for your interest. Based on your initial screening, we determined that you are ineligible for assistance.

Your application will not be reviewed.

Signature Page

PLEASE READ THE FOLLOWING AND SIGN BELOW

Disclaimer

You will be required to verify your crisis. If any provided information or documentation is found to be falsified, your application will be automatically disqualified from receiving assistance.

Confidentiality

We respect your right to receive services while upholding the strictest confidentiality. However, certain laws may require us to breach this confidentiality, such as child abuse/neglect and elderly abuse.

Data Collection

Your information will be entered into a database called Salesforce. Information is only collected that is needed to provide services for you.

The collection and use of all personal information are guided by strict standards of confidentiality as outlined in the Service Provider’s Privacy Policy. You may request a copy of the Privacy Policy.

Records

Records will be maintained for five years.

Refusal of Services

You have the right to refuse services at any time.

You have the right to be treated fairly and honestly by staff and staff expect the same in return.

By signing below, the applicant acknowledges that they have read, understood, and have given consent to proceed.

Further, the parties agree that to the extent they sign electronically, their electronic signature is equivalent to their handwritten signature. Executing an electronic signature has the same validity and meaning as a handwritten signature.

Applicant/Head of Household Signature :

Enter your name

Date Signed :

IMPORTANT

It is highly recommended you print or save a pdf copy of your application on the next page. You will have one final opportunity to review all details on the next page. After you click the 'Submit' button on the next page, you will no longer have access to your application.