Rental Assistance Request
If you are requesting rental assistance please complete this form. AHRI has a wait list and completing this form will place you on the waitlist.
Email *
First Name *
Last Name *
Phone Number *
What county do you live in? *
How many people are in your household? *
What is the estimated total current annual income for all members of your household? (include unemployment, but do not include stimulus payments) *
Does anyone in your household have a disability? *
What is your financial hardship due to COVID-19? *
Required
How did you hear about our program?
Are you currently homeless or staying with friends/family in crowded living situation? *
Required
Is anyone in your household a veteran?
Is anyone in your household over age 62?
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy