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011 322 44 56
8500 Beverly Boulevard Los Angeles, CA 90048
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Applicant's Information
Full Name
*
Full Address
*
Phone Number
*
Email
*
Rental Property Information
Number of Bedrooms in Your Apartment
*
Select
1
2
3
4
5
6
7
Number of people living with you (including self)
*
Select
1
2
3
4
5
6
7
Monthly Rent Amount
*
Amount of Support Requested
*
Reason for Support Request
*
Landlord’s/Property Manager’s Name and Address
*
Relationship to Applicant 1
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 2
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 3
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 4
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 5
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 6
Full Name
Monthly Income
Rent Contribution Amount
Relationship to Applicant 7
Full Name
Monthly Income
Rent Contribution Amount
Have you or your family received S.H.A.R.E. rental assistance in the past 12 months?
Yes
No
No Sure
If YES, when
Ethnicity
Select
Hispanic or Latino
Black or African American
Native American or American Indian
Asian
Other
Declaration and Consent(please read, check mark each box and sign at the bottom)
*
Select All
This is my application and all of the information in it is true, correct and complete
I permit Key Community Housing to obtain a copy of my lease, my photo ID and proof of income to support the verification of the information in this application to assess eligibility for rental assistance. I understand this may take up to 3 business days before a decision is made.
I understand that, if awarded, rental assistance funds will be paid directly to the leasing office of where I reside instead of to me and that this application does not guarantee rental assistance
Signature
Date
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