RARA Housing Support Form
Please fill out this form to start a request for housing support, including past due rent, a security deposit, or help with homelessness. We are only able to assist residents of Rockbridge County. Someone from RARA will call you within 2 business days to complete the full application.

Requests may also be made by phone at (540) 463-6642. Phone applications are accepted Monday-Thursday 9:30am-12pm. We can only help with 1 type of request at time, so please decide if you would prefer housing support or utilities assistance before filling out the application.

If you need food assistance, the Neighborhood Grocery is open Monday/Wednesday/Thursday from 2:30-4:30pm and Saturday from 10am-12pm. You may also schedule a pick-up order at another time at www.raralex.org.
Sign in to Google to save your progress. Learn more
First and Last Name *
Phone Number *
Email Address
Have you received assistance from RARA before? *
Which do you need help with? *
Required
If you need help with rent or a security deposit, what is your landlord's name and phone number?
RARA will need to call your landlord to confirm the amount owed in order to help.
Is there any time you are NOT available for us to call back? The application process usually takes about 10 minutes.
Do you prefer speaking to someone in Spanish? / ¿Prefiere hablar con alguien en español?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms