Rent, Mortgage, and Utility Assistance Application

Please complete this application if you are seeking rent, mortgage or utility assistance due to a crisis or recent loss of employment.

By clicking the button below, I agree that all information I provide in this application will be shared with nonprofit partners who provide rent and utility assistance.

I agree

What do you need assistance with?

RentMortgageUtilities

Address Information

What county do you live in?

Zip Code

Please enter your zip code

Enter other county (Please note we can not guarantee assistance based on your geographic location outside the Atlanta Metro area)

Enter other zip code (Please note we can not guarantee assistance based on your geographical location outside the Atlanta Metro area)

What is your current living situation?

This program is specifically for those facing eviction from a current rental or owned home. If you need housing or homeless services within the City of Atlanta please contact one of the Coordinated Entry Access Points listed at https://partnersforhome.org/access-points/ or visit the Gateway Center at 275 Pryor St. SW, Atlanta GA 30303.

If you need move-in financial assistance or rapid rehousing in Atlanta, please email Crossroads at info@crossroadsatlanta.org or call 470-225-1995

Rental Information

What date did you move into your address? (month & year)

How much rent or mortgage assistance are you seeking? (Please note we can not guarantee your specific amount requested will be met)

What amount can you put towards this balance?

What is the landlord's business name or Apartment Complex (who a check would be made out to)?

Is your lease/mortgage in any way associated with Atlanta Housing Authority or HUD? (Housing Choice, Section 8, subsidized program)

YesNo

How much for power bills? (Please note we can not guarantee your specific amount requested will be met)

What amount can you put towards this power bill?

How much for gas bills? (Please note we can not guarantee your specific amount requested will be met)

What amount of money can you put towards this gas bill?

How much for water bills? (Please note we can not guarantee your specific amount requested will be met)

What amount can you put towards this water bill?

Please explain what utility and how much for utility support? (Please note we can not guarantee your specific amount requested will be met)

Is your name on the lease or mortgage from a landlord or professional property management company?

YesNo

Please continue filling out the application. You may be contacted for further clarification as assistance may not typically be available for private rental agreements.

Please explain.

Have you worked in the food service industry in the past 6 months?

Yes No

Are you able to pay your rent/mortgage and/or utility expenses going forward?

YesNo

The Rental Assistance program is specifically for those individuals facing eviction from a current rental or owned home. In order to qualify you must have a path forward to pay your rent or mortgage.

Do you have a child under the age of 18 living with you?

YesNo

Are you or someone else in your household a veteran?

YesNo

If applicable, when did you last receive rent, mortgage or utilities assistance?

Agency Name

Thank you for filling out this form. Please press Submit when you are ready

Contact Information