77 Fair Drive, Costa Mesa, CA 92626

Question Title

* 1. Do you rent a residence in the City of Costa Mesa?

Question Title

* 2. Is your annual income (from all sources) LESS THAN the amount listed for your household size below?

Annual income is the gross amount of income of all adult household members that is anticipated to be received during the coming 12-month period.

Question Title

* 3. What is your household size?

Question Title

* 4. Are there minor children (under age 18) in your household?

Question Title

* 5. Do you pay 50% or more of your monthly income toward housing costs (rent plus gas, electricity, water and sewer)?

For Example:
If you pay $1,000 or more for housing costs (rent+gas+electricity+water) and you have a $2,000 monthly income, then you pay 50% or more of your monthly income toward housing costs and would answer "yes" below.

Question Title

* 6. If you could receive rental assistance, paid directly to your landlord, to reduce your rent to 30% of your monthly income for up to 24 months, would you apply?

Using the income and rent amounts listed "For Example" in question 5, you would be responsible for $600 of the total rent of $1,000 each month that you are eligible for the assistance.

Question Title

* 7. If you would like to be notified of rental assistance opportunities through the City of Costa Mesa when they are available, please provide your contact information below (name and address, phone, or email). 

T