REACH Center Youth and Young Adult Rental Assistance - Formstack

The Eviction Rent Assistance Program serves eligible Pierce County youth households who have at least one month of rent not paid or partially unpaid since March 1st, 2020. To receive these funds from The REACH Center, the head of household must be between 18 and 24 years old.

About the Eviction Rental Assistance Program

- Households are eligible to receive up to three (3) months of emergency rent assistance between now and December 31st, 2020, or until funding is no longer available.

- Rent payments due prior to March 1st, 2020, are not eligible.

- Funds are for rent payments only, and cannot cover utilities or any fees.

- Payments are made directly to landlord / property owners.

- Current household income (average over last 60 days) must be at or below 80% of Area Median Income (AMI). Income includes all adult (18 years and older) household members and unearned income attributable to a minor. A household is one or more individuals seeking to maintain housing together.

Attaching documents to your application is optional; however, you will be asked to provide it once your application is processed for payment. To expedite your application process, please attach now, or be prepared to provide copies of the following at a later date:

1. ID indicating your birth date

2. First page of your Lease/Rental Agreement

3. Official document showing proof of income or lack thereof. May include:

- (2) Paystubs from the past two months;

- Letter or email from employer documenting job loss, layoff or closure of place of employment;

- Unemployment insurance benefit statement.

How old are you?*

You do not meet the criteria to apply for rental assistance from the REACH Center.

You do not meet the criteria to apply for rental assistance from the REACH Center.

Do you live in Pierce County?*

Yes No

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

Do you have a rental lease in your name?*

Yes No

You do not meet the criteria to apply for rental assistance through ERAP, but you may be able to receive assistance from from the REACH Center.

Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

Have you missed a rent payment since March 1, 2020?*

Yes No

You do not meet the criteria to apply for rental assistance from the REACH Center at this time. Please apply if you miss a rent payment in the future.

Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

How many people live in your household?*

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

You do not meet the criteria to apply for rental assistance from the REACH Center. Please visit https://www.piercecountywa.gov/6859/Human-Services-COVID-19-Help for additional rental assistance resources.

What was your household's income last month?*

If you are on unemployment, please INCLUDE the $600 per week you may have received via the Federal Pandemic Unemployment Compensation program

Based on your responses you are eligible to apply for the REACH Center Rental Assistance. Please fill out the application in the next section.

Based on your responses you may be eligible to apply for the REACH Center Rental Assistance. Please fill out the application in the next section. We will follow up with supplemental screening questions.

Name*

First Name

Last Name

Email*

Phone*

Ok to text?*

Yes No

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

How many adults live in your household? (Including you)*

Head of Household Monthly Income (Last month)

Head of Household Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #2

First Name

Last Name

Household Member #2 Monthly Income (Last month)

Household Member #2 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #3

First Name

Last Name

Household Member #3 Monthly Income (Last month)

Household Member #3 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #4

First Name

Last Name

Household Member #4 Monthly Income (Last month)

Household Member #4 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #5

First Name

Last Name

Household Member #5 Monthly Income (Last month)

Household Member #5 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #6

First Name

Last Name

Household Member #6 Monthly Income (Last month)

Household Member #6 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #7

First Name

Last Name

Household Member #7 Monthly Income (Last month)

Household Member #7 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

Name of Household Member #8

First Name

Last Name

Household Member #8 Monthly Income (Last month)

Household Member #8 Income Type

Wages / Salary Self Employment Unemployment Disability TANF / Public Assistance Alimony / Child Support / Foster Care Payments Armed Forces Income No Income

Other:

How do you identify your Gender?

How do you identify your Ethnicity?

How do you identify your Race?

African-American/ Black American Indian or Alaska Native Asian/Asian-American Caucasian/White Multiple Races Native Hawaiian or Other Pacific Islander Don't Know Prefer Not to Answer

Other:

Number of months behind in rent*

Have you made any partial rent payments?*

Yes No

Indicate the month(s) you made partial rent payments and the amount you paid*

Example: March $250 paid, April $250 paid

Which months are you behind in rent on?*

March 2020 April 2020 May 2020 June 2020 July 2020 August 2020 September 2020 October 2020 November 2020

Rent payment per month* $

How many bedrooms are in your rental unit?*

0 1 2 3 4 5

Other:

Apartment/Complex Name*

Landlord Name*

First Name

Last Name

Is your landlord a friend or family member?*

Landlord Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Landlord Phone*

Landlord Email*

Do we have permission to contact your landlord / property owner on your behalf?*

Yes No

Payments will be made directly to landlord / property owners.

Attaching documents to your application is optional; however, you will be asked to provide these documents once your application is processed in order for rent payment to occur. To speed up the process, please attach them now, or prepare to provide them at a later date:

1. A copy of an ID that includes your birthdate

2. A copy of the first page of your lease agreement

3. Proof of income

- Most recent paystub(s) documenting a month of pay OR

- Letter from former employer documenting job loss OR

- Unemployment insurance benefit statement

Please upload a photo or copy of your ID No File Chosen

File uploads may not work on some mobile devices.

Attaching documents to your application is optional; however, you will be asked to provide it once your application is processed for payment.

Please upload a photo or copy of the front page of your lease agreement No File Chosen

File uploads may not work on some mobile devices.

Attaching documents to your application is optional; however, you will be asked to provide it once your application is processed for payment.

Please upload your proof of income No File Chosen

File uploads may not work on some mobile devices.

Most recent paystub(s) documenting a month of pay OR Letter from former employer documenting job loss OR Unemployment insurance benefit statement

Do you want to upload proof of income for another household member?

Yes No

Uploading all documents now will help to speed up the process. If you do not upload now, you will be asked for documentation later.

Proof of Income #2 No File Chosen

File uploads may not work on some mobile devices.

Do you want to upload proof of income for another household member?

Yes No

Uploading all documents now will help to speed up the process. If you do not upload now, you will be asked for documentation later.

Proof of Income #3 No File Chosen

File uploads may not work on some mobile devices.

Original Formstack ID

Assigned to

Alonna Cheryl Kerrisan Mischa Olivia

Check Request Sent

Yes No

# of months of rental arrears paid

# of months of current/future rent paid

% AMI

Date approved

Date Paid

Check Number

Check Amount

Receipt Sent

Yes

Case manager notes

Client contacted to reapply

Yes Not eligible to reapply

Case Status

Open Closed

Progress

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