Please Note:

This is not an application. Completion of this screening does not qualify nor disqualify you from any supportive services (including rental assistance). 

Please note: There is currently a 2-3 month long wait list for rental assistance. 

Based on the needs of each household, support could include emergency rental assistance, rental arrears and late fees, utility assistance, landlord mediation/advocacy, new move-in expenses and employment assistance for individuals who reside within the City of Carlsbad.

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* Who is completing this screening? 

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* Do you currently reside within the City of Carlsbad?

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* Do you have a current lease or prelease agreement in the City of Carlsbad? 

Select no if you plan to rent within Carlsbad but have not been approved for a unit .

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* Please provide the following contact information.
We will only utilize this information to contact you regarding your screening. 

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* Date of Birth (Head of Household)

Date

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* What is your total household income per month?

Income may be defined as and includes all cash benefits that your household receives. 

 
20% of survey complete.

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