Gwinnett Eviction Prevention Screening Form
This form has been developed for Gwinnett County renters who are facing a potential eviction. This form is utilized to conduct a preliminary eligibility check and to identify the appropriate resource for renters in need. Filling out this form in no way guarantees that assistance can or will be provided.
* Required
First Name
Your answer
Last Name
Your answer
Date of Birth
Please make sure to enter the correct year- doNOT enter 2020
Date
E-Mail Address
*
Your answer
Telephone Number
Your answer
How many adults live in your household?
Your answer
How many children live in your household?
Your answer
Is anyone in your household a veteran?
Yes
No
Refused
Other:
Clear selection
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