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Rental Assistance Request
If you are requesting rental assistance please complete this form. AHRI has a wait list and completing this form will place you on the waitlist.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
What county do you live in?
*
Choose
Aransas
Bee
Brooks
Calhoun
Dewitt
Duval
Goliad
Gonzalez
Jackson
Jim Wells
Kenedy
Kleberg
Lavaca
Live Oak
Mc Mullen
Nueces
Refugio
San Patricio
Victoria
How many people are in your household?
*
Choose
1
2
3
4
5
6
7
8
8+
What is the estimated total current annual income for all members of your household? (include unemployment, but do not include stimulus payments)
*
Choose
0-20,000
20.000 - 30,000
30,000 - 40,000
40,000 - 50,000
50,000 - 60,000
60,000 - 70,000
70,000 - 80,000
over 80,000
Does anyone in your household have a disability?
*
Yes
No
What is your financial hardship due to COVID-19?
*
Since March 13th I/we have had a loss of income of 20% or more due to Covid 19
Since March 13th I/we have had increased expenses due to school closure or increased medical expenses.
Other:
Required
How did you hear about our program?
Your answer
Are you currently homeless or staying with friends/family in crowded living situation?
*
Yes
No
Required
Is anyone in your household a veteran?
Yes
No
Is anyone in your household over age 62?
yes
No
Send me a copy of my responses.
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