Please complete this application if you are seeking rent, mortgage or utility assistance due to a crisis or recent loss of employment.
Average completion time: 20 minutes.
Please note ARCHI and our partners will never ask you for money at any point during the rental assistance application process.
By clicking the button below, I acknowledge and consent that Georgia State University (GSU), on behalf of the Atlanta Regional Collective for Health Improvement (ARCHI) may collect, retain, and use the information provided through this form — including personally identifiable information (PII) such as my name, date of birth, address, contact information, financial details, and household composition — for the purposes of teaching, academic research, program evaluation, and institutional reporting. I further consent that GSU may share this information, including PII, with partnering organizations, agencies, and researchers under appropriate data-sharing agreements that include adequate privacy and security protections, and in accordance with all applicable federal, state, and local laws. I understand that any partner receiving my PII will be contractually obligated to safeguard it and to use it only for the purposes specified in the applicable data-sharing agreement.