Rental Assistance Grant Application

Please complete all required fields and share documentation to be considered for an emergency rental assistance grant. Garfield Park Community Council (GPCC) is facilitating this program through the City of Chicago Department of Housing. Please review the eligibility requirements for the program prior to completing an application.

Contact Information

Name

First Name

Last Name

Verify Email

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Age

Gender Identity

Male

Female

Gender non-conforming

TransFemale

TransMale

Prefer not to respond

Ethnicity

Hispanic/Latinx

Non-Hispanic/Latinx

Prefer not to respond

Race

White

Black

Asian

American Indian

Alaskan Native

Hawaiian/Pacific Islander

Prefer not to Respond

Other

Education

GED/High School

Some college

Associates

Bachelors

Masters / Professional Degree

No diploma

Are you a female head of household?

Yes

Household Size

Include all adults.

Are you an active military member?

Yes

Marital Status

Single

Married

Widowed

Divorced

Separated

Do you identify as a person with a disability?

Yes

Are you employed?

Yes

Type of Employment

Full-Time

Part-Time

Seasonal

Self-Employed

Unemployed

Hire Date

(mm/dd/yyyy)

Layoff or Furlough Date

(mm/dd/yyyy)

Current Annual Income

Date of COVID-19 Impact

(mm/dd/yyyy)

Have your hours been reduced due to COVID-19?

Yes

If your hours have been reduced, how many have been reduced?

Have you applied for Unemployment?

Yes

Are you receiving Unemployment?

Yes

Total Monthly Rent

Landlord's Name

First Name

Last Name

Landlord's Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Landlord's Phone Number

How do you pay your rent?

Check

Money Order

PayPal

Other

If other, please explain:

Do you have a lease?

Yes

How did you hear about us?

Social Media

Elected Official

Partnering Non-Profit

City of Chicago

Family/Friend

Other

Would you be interested in sharing your story?

Yes

Required Documentation

In addition to completing this application, please share copies of the required documentation listed on our website regarding your proof of income, financial hardship, and rental costs. Drop off your documentation at a secure mailbox located at 4215 W. Washington, upload them to this form, or email them to organizer@gpcommunitycouncil.org.

The following documents are required, at minimum. You may be asked to provide additional documentation.

1. Government-issued ID: If the address does not match please send two pieces of mail with your current address.

2. Current Income Documentation: If your income is $0 then send a letter explaining your income, OR your 2019 1099 or 2019 W2; OR an unemployment letter; OR a TANF benefit letter; OR a SNAP benefit letter; OR a 2019 tax return, OR a 2019 1099 form.

3. Current Lease Agreement

4. Rent receipt - proof of payment of rent.

5. Explanation of how your job was affected by COVID-19; send either an unemployment letter or a letter from employer stating that your hours were reduced or you were laid off.

Government-issued ID or Drivers' License with current address

Please attach a scan or image

Household Income Documentation 1

Please attach a scan or image

Household Income Documentation 2

Please attach a scan or image

Rental Documentation (Lease) 1

Please attach a scan or image

Rental Documentation (Rent Receipt) 2

Please attach a scan or image

Employment or Financial Hardship Documentation

Please attach a scan or image