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Truro Emergency Rental Assistance Application

Please complete the following application. If you need assistance, please call our office at (508) 255-9667 and ask to speak with a case manager. Click here to download a printable application you can send to HPC at PO Box 828, Orleans, MA 02653.

Once your application is received, a case manager will review your information and be in touch.

Contact Information

Applicant's Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Phone Number

Please use your preferred, best number to call.

Verify Email

Language Preference

Identify your language preference if different than English.

Total Number of People in Household (including yourself)

Total Number of People in Household 18 Years or Older

Total Number of People in Household 18 Years or Younger

Is anyone in your household age 55 or older?

Yes

This program is for people who have lost income or had an increase in expenses due to COVID-19 related circumstances. Does your household meet this eligibility?

Yes

Briefly describe your situation:

How many bedrooms are in your home?

Is anyone in your household a veteran?

Yes

Do you have a Section 8 Voucher, MRVP, or other rental assistance?

Yes

What type of assistance are you requesting?

Rent Stipend

First/Last/Security/Arrears

What is your current rent each month?

Do you have a current Unemployment Assistance application?

Yes

Check types of income being received in your household by anyone over 18 years of age:

Wages/self-employment

Unemployment Benefits

Social Security

SSI/Disability

Child Support

Alimony

Pension/Retirement

TANF

Other

Do you or any member of your household classify yourself as any of the following?

This may include more than one group.

Native American/Alaskan

Asian

Black/African-/Caribbean-American

Native Hawaiian/Pacific Islander

White/Caucasian

Latinx

Another Race or Ethnicity

Please specify other race or ethnicity:

Landlord's Contact Information

To receive rental assistance landlord MUST participate in this program. If this is left blank the application is incomplete and will not be considered.

Landlord's Name

First Name

Last Name

Landlord's Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Landlord's Phone Number

Please provide your landlord's best, preferred telephone number.

Landlord's Email

Verify Email

Certifications

I/We certify that all information furnished in this application for emergency rental assistance is true and complete to the best of my/our knowledge.

Yes

I/We certify that our household does not have access to other resources sufficient to cover housing.

Yes

I/We understand that this authorization or the information obtained with its use may be given to and used to administerand enforce program rules and policies in compliance with HUD or Massachusetts DHCD or any other federal or state housing program rules.

Yes

I/We understand that any false statement, made knowingly and willfully, will be sufficient causefor rejection of my/our application.

Yes

I/We understand that landlord participation in this program is required.

Yes

I/We understand that ANY false information on this application or statements given are punishable by law and will lead to cancellation of this application and rental assistance.

Yes

Applicant's E-Signature

Please print your full name.

Date

(mm/dd/yyyy)

Co-Applicant's E-Signature

Please print your name.

Date

(mm/dd/yyyy)

Release of Information

I/We hereby authorize Homeless Prevention Council to discuss any and all matters regarding this application with my landlord.

Yes

I/We agree that a photocopy or facsimile or other electronic transmission of this authorization may be used for the purposes stated above.

Yes

I/We understand that all decisions made by Homeless Prevention Council are final and that any appeals must be submitted in writing to the Appeals Board.

Yes

Application Checklist

THESE MUST BE INCLUDED WITH YOUR APPLICATION OR IT WILL BE DEEMED INCOMPLETE.

Paystubs from four most recent weeks for all employed household members over the age of 18.

Evidence of reduced income –this might be a second paystub showing reduced hours, or a lay-off notice from your employer, multiple month’s bank statements or notices from Unemployment Assistance.

Evidence of any other income sources (unemployment, child support, alimony, pension/retirement, etc.)

Most recent bank statement for all bank accounts for all household members over age 18.

Copy of Lease or letter from landlord evidencing monthly rent amount.

Verification of funds needed toward first, last, and security.

Verification of Rent Arrearage from Landlord