COVID-19 Rent Relief Request Form
Applicant Information
Full Name
Phone Number
Email Address
Rental Address
Unit/Apt #
City
Landlord Information
Landlord Name
Landlord Phone
Landlord Email
Relief Details
Monthly Rent Amount
Months Needing Relief
Describe Your COVID-19 Hardship
Has your income changed due to COVID-19?
Yes
No
Employment Status
Employed
Unemployed
Reduced Hours
Other
Additional Comments