Request edit access
Pre-screening for rent/mortgage assistance
Please read this form carefully and complete it to the best of your ability.
You will be contacted to verify any information if you meet the requirements for rent or mortgage assistance.

Please submit only one form.
Sign in to Google to save your progress. Learn more
This request is for rent or mortgage only. To apply for utility assistance, please fill out the utility assistance request form. If you fill out both applications, you will NOT be accepted for both *
MEAC's ability to help with rent or mortgage depends on whether or not we have funding. *
If MEAC does have funding, assistance is not guaranteed. *
If MEAC does not have funding, you may not receive a response from MEAC after you fill out this form. *
If the form is not filled out completely, your application will be rejected. *
MEAC does not provide help with security deposits *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Madisonville Education and Assistance Center.

Does this form look suspicious? Report