Assistance Programs (Applicant Intake Form)

Main Applicant Information (Typically the Main Person on the Lease)

Main Applicant's First Name *

Phone Number *

Current Address *

City *

Main Applicant's Last Name *

Email *

Apt/Unit Number

State *

Zip Code *

Is there a Co-Applicant? *

Yes

Co-Applicant's First Name *

Phone Number *

Co-Applicant's Last Name *

Email *

Requested Support *

Hardship Explanation *

Have You Already Applied for Assistance with Another Program? *

Yes

After the Assistance Ends, What do you or Will you have in Place as a Sustainability Plan to Afford the Rent on Your Own?

What is the Program Name? *

Upload PDF/ JPEG Receipt of Application Submission *

Case Number *

Have you Been Assigned a Case Manager? *

Yes

Case Manager Name *

Case Manager's Phone Number *

Case Manager's Email *

READ BEFORE YOU SUBMIT

Your Information Provided will be Used to Notify Management.

Please Know that your Next Step is to Apply with a Program on the Following Page.

Once you Submit, you "MUST" Select & Apply to a Program that Best fits you and/or your Family's Needs.
Once you Apply, Email LeasingNV@gmail.com with the Below Requested ItemsA) Selected Program Name
B) Program Application Submission Receipt

C) Program Reference/Case Number

D) Case Manager Name

E) Case Manager Email

F) Case Manager Phone Number & Extension

3. Monitor Your Email! A Digital "Authentisign" will be Emailed Within 2 Business Days & "MUST" be Signed for Landlord Cooperation

Verify Your Understanding: *

I've Read, Understand, and Will Cooperate with the Above Information and Instructions on this Web Page

I've Printed or Screenshotted these Instructions for my Records