RENTAL ASSISTANCE PROGRAM (RAP) APPLICATION
IF YOU ARE IN NEED OF RENTAL ASSISTANCE PLEASE SUBMIT ALONG WITH THE ADDITIONAL PIECES OF DOCUMENTATION REQUESTED IN ORDER TO BE CONSIDERED FOR OUR PROGRAM. THE ADDITIONAL REQUESTED
DOCUMENTS ARE LISTED AT THE BOTTOM OF THIS FORM.
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PERSONAL INFORMATION
First and Middle Name: *
Your answer
Last Name: *
Your answer
Home Street Address: *
Your answer
City: *
Your answer
State: *
Your answer
ZIP Code *
Your answer
Home Phone No.: *
Your answer
Work Phone No. *
Your answer
Cell No.: *
Your answer
Email: *
Your answer
Date of Birth: *
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Social Security No.: *
Your answer
Marriage Status *
Children or Dependents: *
Number of Children or Dependents: *
Your answer
Age of Children or Dependents *
Required
Pets: *
RENTAL HISTORY
Full Address: *
Your answer
Check if same as above:
Owner/Manager Name: *
Your answer
Owner/Manager Address: *
Your answer
Owner/Manager Phone No.: *
Your answer
Owner/Manager Fax No.
Your answer
Owner/Manager Email: *
Your answer
All Other Occupants *
1) Full Name:
Your answer
Relation: *
Your answer
2) Full Name: *
Your answer
Relation *
Your answer
Others & Relations: *
Your answer
Date In: *
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Date Out: *
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CHECK if applicable *
Required
Rent $: *
Your answer
Rent owed when: *
Total Rent Amount Owed: *
Your answer
Total due by: *
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Time
:
Reason for Rent Money Coverage: *
Your answer
Previous Landlord/Mortgagor's Name or Company's Name: *
Your answer
Previous Landlord/Mortgagor's Name or Company's Address: *
Your answer
Previous Landlord/Mortgagor's Name or Company's Phone No. *
Your answer
Previous Landlord/Mortgagor's Name or Company's Fax No.
Your answer
Previous Landlord/Mortgagor's Name or Company's Email: *
Your answer
Reason for leaving prior residence: *
Other information:
Your answer
EMPLOYMENT HISTORY
Present Occupation or Source of Income *
Your answer
Employer Name: *
Your answer
Supervisor's Name (Contact Name): *
Your answer
Employer Address *
Your answer
Employer Phone No: *
Your answer
Employer Email: *
Your answer
Start Date *
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End Date:
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Prior Occupation or Source of Income *
Your answer
Employer Name: *
Your answer
Supervisor's Name (Contact Name): *
Your answer
Prior Employer Address *
Your answer
Prior Employer Phone No. *
Your answer
Prior Employer Email: *
Your answer
Start Date: *
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End Date *
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Other sources of Income *
Required
Current Gross Income per month $: *
Your answer
Current Net Income per month $: *
Your answer
Monthly Expenses: *
Required
CHECKLIST TO COMPLETE THE APPLICATION PROCESS
Please provide the following documentation along with your application. *
This is necessary for approval of the application, although we may request additional information depending on your situation. These documents can be sent via email to myrembayarea@gmail.com subject: RAP APPLICATION DOCUMENTS or they can be faxed at 415.276.8939 or at 866.549.4799.
Required
CONFIDENTIALITY
1) MYREM, Inc. shall use the confidential information only for the purpose of evaluating potential financial aid with Applicant; & 2) MYREM, Inc. shall limit disclosure of confidential information within its own organization to its directors, officers, partners, members and/or employees having a need to know and shall not disclose confidential information to any third party (whether an individual, corporation, or other entity) without the prior written consent of Applicant. *
Required
Applicants Signature: *
(Please Type Full Name in Box Below)
Your answer
Date:
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Submit
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