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1. Have you experienced a hardship in 2025 or 2026?

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2. Are you currently employed?

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3. Please provide your zip code in Georgia and what county you live in?

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4. Do you own or rent a home or an apartment?

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5. Is the place you need assistance with your primary residence?

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6. Are you able to provide documentation showing that you are currently past due on your rent or mortgage payments and that your name appears on the current lease agreement or mortgage?

*Examples include a signed lease agreement, mortgage statement, eviction notice, or past-due payment notice.

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7. Have you or individuals in your household qualified for unemployment benefits?

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8. Are you or members or your household experiencing homelessness or housing instability?

If so, have you also experienced the following?

*Has received a rental eviction notice or a mortgage foreclosure notice.
*Experiencing a housing cost burden.
*Forgoing or delaying the purchase of food, prescription meds, childcare, or similar essential necessities.

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9. How many children are in your home or apartment?

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10. What is your name, email, and phone number?

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