top of page
Application with house

Rent Assistance  
Pre-Screen Application

Rent Assistance Form

This application is now closed, we are no longer accepting submissions. Please check back at another time.

This form no longer accepts submissions.

When is your rent payment due?
Do you
In which type of housing do you currently live?
Are you living in subsidized housing, recovery housing, transitional housing, an organized group home, or does the amount of rent change if your income changes?
Do you pay utilities?
Which ones?
Any utilities or fees included in your rent amount?
Is there anyone in the household over 58 years old?
Has anyone in your household experienced domestic violence in the last 12 months?
Is anyone in your household pregnant?
Are all adults on the rental agreement?
Do you and your roommates have separate rental agreements?
Do you have money available to contribute to your rent arrears?
Do you owe previous months?
Are you receiving / have received any housing assistance from CCS or any other agency in the last 12 months?

Thanks for submitting!

bottom of page