Please Note:

Completion of this screening does not qualify nor disqualify you from any supportive services (including 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.

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* Who is completing this screening? 

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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. 

 
17% of survey complete.

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