Are you currently employed?
Are you currently behind on paying rent?
Number of Months Behind
Total Amount Owe
Is your current rent affordable moving forward?
Has your household faced increased expenses since March 2020 due to the COVID-19 pandemic?
Do you receive any government assistance?
Are you currently behind on any utility bills?
What is the approximate combined total household annual income?
Has your household's income decreased since March 2020 because of the COVID-19 pandemic?
Have you received an eviction notice or a court summons?