Application Start - Lev27.org

Assistance Application

Step 1 of 6

16%

Today's Date(Required)

MM slash DD slash YYYY

Referring Individual or Organization

Court Docket Number(Required)

Applicant must have legal proceedings against them already to be eligible for the program

Name of Applicant(Required)

First Last

Application Information

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Phone(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Preferred Contact Method

Phone

Household Information

Total Humber of Occupants(Required)

Please enter a number from 1 to 15.

Number of People in your Household

Number of Dependants(Required)

Please enter a number from 1 to 20.

Number of children, elderly, etc

Rent and Housing Details

Current Housing Situation(Required)

Renting, leasing

Monthly Rent Amount(Required)

What is the total amount of rent (or housing payments) currently in arrears?(Required)

What is the deadline by which the arrears must be paid?(Required)

MM slash DD slash YYYY

Has your landlord agreed to allow you to remain in the property if the arrears are fully satisfied?(Required)

Yes

Landlord / Property Manager Name(Required)

First Last

Name of your Landlord or property manager

Landlord / Property Manager Company (Optional)

Landlord / Property Manager Contact Information(Required)

Phone, email, mailing address

Financial Situation

Employment Status(Required)

Employer Information(Required)

Company Name, Phone, email, mailing address

Monthly Household Income(Required)

Additional Income(Required)

Child support, investments, freelance work

Supporting Documents

Supporting Documents(Required)

Drop files here or

Max. file size: 1 GB, Max. files: 6.

Include Proof of Income: Paystubs, bank statements, Proof of Dependents, Rental Agreement

Hardship Description(Required)

What was the event that caused you to need rental assistance? Please explain

Landlord Contact Consent(Required)

I authorize LEV 27 to communicate with my landlord using the contact information provided above

Employer Contact Consent(Required)

I authorize LEV 27 to communicate with my employer using the contact information provided above

Declaration(Required)

I hereby declare that the information provided is accurate and complete to the best of my knowledge. I understand that providing false information may result in disqualification from rent assistance.

Signature(Required)

Assistance Application

Application Information

Household Information

Rent and Housing Details

Financial Situation

Supporting Documents

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