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

By clicking the button below, I understand that I may need to wait 2-4 weeks to hear back from a matched agency or from ARCHI. Submitting multiple applications will not improve the likelihood of receiving assistance.

I agree

First Name

Last Name

Date of Birth

mm/dd/yyyy

Phone number

Email address

Home address

Input your street address and apartment number(if applicable)

City

State

Zip Code

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/ova_doc/coordinated-entry 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

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

YesNo

What is your monthly rent/mortgage payment?

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

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