CCI Rental Assistance Form

CommunityConcerns,Inc."a holistic approach to end homelessness"

Name: *

No. of Adults in Household: *

Type of Income: *

Amount of Rental Assistance Needed: *

Upload Here or Email Required Documents to kai.franklin@communityconcernsinc.com *

Required Documents Checklist:

Valid State ID

Copy of Lease

Proof of Income

Official Documents of Amount Owed

Phone: *

No. of Children in Household: *

Total Household Income: *

Email Address: *

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Total Household Income Instructions

*Must use 60% AMI. Please See Chart at the link below.

Address: *