Rental Assistance Request
This is not an application for rental assistance. This form puts you on a waitlist to receive help with your application once StopMyEviction.org re-opens. If you have a court date, please go to the first page of StopMyEviction.org and follow the directions there.

You can also go to Neighborhood Place and get an assistance appointment.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address *
Phone Number *
Preferred Contact Method (please only choose one)
Street Address *
City (We can only assist Jefferson County, KY)
Zip *
Date of Birth *
MM
/
DD
/
YYYY
Landlord Name *
Landlord Phone *
Landlord Email *
Monthly Rent *
Total Amount Owed *
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