Brookline CDC Rent Assistance Application Form

This application is Step 1 of 3 Steps that MUST be completed to be eligible for financial assistance.

  • Step 1 - complete and submit this application form
  • Step 2 - work directly with MWCD to submit income & eligibility documents
  • Step 3 - meet with Brookline CDC to create plan of action around your needs

Instructions

Please answer all questions.

Incomplete or unsigned applications will not be processed. Only one applicant per household may apply.

Do you have a disability and need a reasonable accommodation?

The staff of Metro West Collaborative Development (MWCD) is available to help you complete your application. If you have a disability which makes completing this application more difficult, you have the right to request a reasonable accommodation, which may include a change to a rule, policy, procedure, or practice to allow you to have an equal opportunity to participate fully in the housing program. Please email (preferred) Robyn at robyn@metrowestcd.org or call at 617-923-3505 x105.



















Unexpected Emergency

This program is for people who are behind on their rent and whose household meets the following income limits:

Household size

1 person

2 person

3 person

4 person 

5 person

Income Limit

80% of area median

$92,650

  $105,850

$119,100

$132,300

$142,900


If no, we're sorry but you are not eligible for this program. It is designed for households earning up to 80% AMI.







LANDLORD'S CONTACT INFORMATION

Emergency Rent Assistance is paid directly to your landlord.  Your landlord MUST participate in this program in order to receive rental assistance. If this section is left blank, the application is incomplete and will not be considered.

 

Metro West CD will reach out to your landlord to confirm their participation in this program. Please provide:






You must submit the following supporting documentation:



Certifications

(Must be signed by Applicant)


  • I certify that my/our household income is BELOW the following based on household size (income limit is 80% area median)

Household size

1 person

2 person

3 person

4 person 

5 person

Income Limit

80% of area median

$91,200

 $104,200

$117,250

$130,250

$140,700

  • I certify that all information furnished in this application for emergency support assistance is true and complete to the best of my knowledge.
  • I understand that any false information, made knowingly and willfully, will be sufficient cause for rejection of my/our application.
  • I understand that this is a one-time grant for the entire household and that no other members of my household have applied nor will apply during the term of this program.
  • I understand that ANY false information on this application or statements given are punishable by law and will lead to cancellation of this application and the emergency support assistance.


Typing your name acts as a signature

Release of Information

(Must be signed by Applicant)


I hereby authorize Metro West CD or its agent to obtain verification from any source named in this application. In addition, I authorize and direct any federal, state, or local agency, organization, business or individual to release information to representatives of Metro West CD, which may be necessary for me to receive this rent assistance.

I understand that this authorization or the information obtained with its use may be given to and used to administer and enforce program rules and policies in compliance with HUD or Massachusetts EOHLC or any other federal or state housing program guidelines.

I hereby authorize Metro West CD to discuss any and all matters regarding this application with my landlord.

I hereby authorize Metro West CD to discuss any and all matters regarding this application with Brookline CDC, which provides funding for this program.

I agree that a photocopy or facsimile or other electronic transmission of this authorization may be used for the purposes stated above.

I understand that this is a one-time grant and that no other person from my household is eligible to apply.

I understand that all decisions made by Metro West CD are final and that any appeals must be submitted in writing to the Metro West CD Board of Directors


Typing your name acts as a signature

Metro West Collaborative Development does not discriminate on the basis of race, color, religion, national origin, disability, familial status, sex, age, marital status, children, sexual orientation, genetic information, gender identity, ancestry, veteran/military status, or membership.

Contact Information