COVID-19 Rental Assistance – August 2020
COVID-19 RENTAL ASSISTANCE PROGRAM
Landlord Documentation
Applicant Name: _________________________________
APPLICANT – As part of your application, you are required to submit certain landlord documents. Please
complete the applicant information below and have your landlord complete the remainder of the form
and attach the documents listed below. Your application must include this information in order to be
considered complete and to be eligible for funding consideration.
Applicant Information:
First and Last Name: ________________________________________
Street Address: ________________________________________
Apt. #: ________________________________________
City and Zip Code: ________________________________________
Phone Number: ________________________________________
LANDLORD – The above-named applicant is a tenant at your property and is applying for the COVID-19
Rental Assistance Program. If the applicant is chosen through a random selection process and is eligible
for assistance, they could receive $600 per month for a maximum of three (3) months (a total of $1,800)
in rental assistance. Rental assistance payments will be made directly to landlords.
In order to be eligible for assistance, the applicant is responsible for submitting certain landlord
documentation, which includes:
(1) Rental license number;
(2) A copy of landlord’s completed W9 form; and
(3) Documentation that provides the above-named applicant is at least one month behind in their rent.
Please complete the form on the back side of this document and provide a completed W9 to the applicant.
You may either submit separate documentation stating that the applicant is at least one month behind in
rent, or you can sign the below statement.
*Applications MUST include the information on this form in order to be considered for assistance.*
Turn over to complete form
