Head of Household Name *

Phone Number *

Email Address

Tenant's Address *

Household Size *

Number of Children (under 18) in the Household *

What are the Ages of the Children in the Household? *

Race (check all that apply for family) *

Where do you live? *

Landlord or Property Manager *

Landlord's Phone Number *

Landlord Mailing Address

Monthly Rent Amount *

Amount Requested *

Requesting Party *

Is this need due COVID 19? *

If this related to COVID 19, please explain *

How much rental assistance is needed for your household to get into a manageable situation? *

Anything else you would like us to know?

Everything stated above is factual and correct to the best of my knowledge? *

Disclaimer: This form is used as a general rental assistance inquiry intake. By filling out this form you give us permission to contact the landlord or tenant related to this request. Our rental assistance program is fully grant funded and therefore requirements can change frequently. Therefore, we cannot not guarantee assistance. We do not discriminate against anyone in anyway for any reason. Some information is used to apply for further grants to fund our program, so Family Promise of Spokane can continue to offer rental assistance to families caring for minor children or pregnant individuals. By entering your name, you have read and agree to these terms. *