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CAPC Rental Assistance (ANTIOCH ONLY)
The Child Abuse Prevention Council (CAPC)'s Rental Assistance, up to $600, is available once per family to families in need. To be eligible, families must have at least one child between the ages of 0-18 living with them. Please note that rental assistance is available once per family and that this is not designed to be emergency assistance and come with a processing time.

To request rental assistance, please complete the following form and the W-9 form (to be completed by the landlord) and submit them. The form must be completed by the service provider (not a family member). CAPC will mail the check to the landlord or the service provider may pick it up at CAPC's Concord location at 2120 Diamond Blvd., #120. 

For additional questions, please email Sofia Stanwood at sstanwood@capc-coco.org.
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Service Provider Name *
Requesting Agency *
Service Provider Phone Number *
Service Provider Email Address *
Amount of Rental Assistance Requested
Landlord's Name (Check Payee)
Landlord's Address
Landlord's City
Landlord's Zip Code
Reason for Need of Rental Assistance *
Monthly Rent *
Other Agency also Providing Rental Assistance (if applicable)
Parent/Guardian's Name *
Number of Children living in the home  *
Primary Child's name *
Family's Address *
Family's City
Family's Zip Code
Primary Language Spoken in the Home
Is the child at risk of being removed from the home?
Plan for sustaining housing after one-time assistance/case plan for the family is required. Please enter here. *
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