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 re-opens. If you have a court date, please go to the first page of and follow the directions there.

You can also go to Neighborhood Place and get an assistance appointment.
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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 *
Landlord Name *
Landlord Phone *
Landlord Email *
Monthly Rent *
Total Amount Owed *
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