Tenant Application

AccountId

Landlord ID

Zip Code

Case Mismatch Error Message

City of Houston

YesNo

Property Program Eligibility

Direct Assistance?

TRUE

Rental Property Name/Address Confirmation

Building/Property Name

Address

Note: If this is not your residence, please go back and select the correct property to begin the application. If this is not your address, payment may be made to the wrong landlord.

I confirm this is the address where I currently live, and that I pay rent at this location.

I confirm that I have searched for my property in the Participation Directory, and it is not listed.

Building/Property Name

Address Search

Type your address and click on the matching result. Please omit unit numbers.

Confirm your property address.

I would like to use the address from the Address Search above.I couldn't find my address or I would like to enter my address manually.

Latitude

Longitude

Precinct

City Council District

Building/Property Address

Building/Property City

Building/Property Zip Code

Help us further identify your specific rental property - do you have an apartment, unit number or lot number?

YesNo

Please enter your Apartment, Unit Number, or Lot Number:

Only include unit number. I.e. 205 or A205 (Not Apt 205, #205, or entire address again with #205)

I understand that rental assistance will be paid directly to my landlord and that the program funds will be applied to past due rent and up to two months of future rent.

I confirm this is the address where I currently live, and that I pay rent at this location.

Landlord/Property Manager Contact Information

Please provide the contact information for your landlord or property manager. We will be contacting them in regards to your rental assistance application.

If you have both your landlord and property manager's information, please provide the information for the person you have most responsive communication with now.

Landlord/Property Manager Name

Landlord/Property Manager Phone Number

Is this a mobile number or landline?

MobileLandline

Landlord/Property Manager Secondary Phone Number (optional)

We strongly encourage you to provide your landlord or property manager's email address. We will not sell or share their email to any other person or organization

Landlord/Property Manager Email

Landlord/Property Manager Secondary Email

Tenant Applicant Contact Information

The individual listed here as the Tenant Applicant must be responsible for making payments to the Landlord. Only one Tenant Applicant per rental property/unit will be considered.

First Name

Last Name

Primary Phone Number

Primary Phone Type

MobileHome

Text Messages

It's ok to text me at this number

Secondary Phone Number (optional)

Secondary Phone Type

MobileHome

Text Messages

It's ok to text me at this number

We strongly encourage you to provide your email address or that of a trusted friend or family member. Email is the fastest way to receive updates on your application status and is the primary way we will let you know if we need additional information to complete your application. We will not sell or share your email to any other person or organization.

Email (optional)

Secondary Email (optional)

Preferred Language

Did you receive assistance from a community organization to complete your application?

YesNo

Which community organization did you receive assistance from to complete your application?

Please add the name of the agency that helped you:

Tenant Applicant Documents

Note: If you are on a mobile device, clicking “Choose file” will allow you to take a photo of your document. You can also upload your documents from your computer. When scanning or taking photos of your documents, please be sure the applicant's name, address and date remain visible, for all documents that include that information.

1. Proof of Tenant Identification. Are you able to provide any of the following documents to serve as a copy of your ID?

Driver’s license or other state-issued ID, U.S. or foreign passport, School ID, Nonprofit membership ID, U.S. visa, Work permit, Legal permanent resident card (Green card), Matrícula consular, Current or expired foreign government issued ID, Office of Refugee Resettlement ID, Work ID, Library card, Handgun license, Military ID, Texas Election ID certificate

YesNo

Please upload a copy of your ID.

2. Proof of Residence at the Rental Property. Are you able to provide a copy of your current lease?

YesNo

Please upload proof of lease.

2a. Proof of Residence at the Rental Property. Are you able to upload any one of the following documents:

Current photo ID, current utility bill (water, gas, cell phone, internet, or other utility provider to applicant at rental unit address), Lease, mail from the government office, financial institution, or utility provider to applicant at rental unit address

YesNo

Please upload proof of residence.

Tenant Rent Information

For the fields below, please enter numbers only. Commas, decimals, and special characters (such as $) are not allowed. You should ROUND DOWN if needed. For example, $1,050.50 should be entered as 1050.

Please enter your current monthly rent amount. If you are a resident of subsidized housing, include only the non-subsidized monthly payment you are responsible for, not the full rent amount.

$

Please add details of your past-due rent below. Enter the total amount you owe for each month, include past due utilities and home energy costs (electricity, gas, water, sewer, trash removal and other energy costs, such as fuel oil or propane) if you pay these costs directly to your Landlord. At least some of your rent amount be past due in order to submit this application.

Month

Amount Due/Requested

$

Amount difference

Total Past Due Amount:

Months

Future Rent Information

The Houston-Harris County Emergency Rental Assistance Program is able to cover up to two months of future rent. NOTE: This assistance is only available if you expect to remain in your current residence for one-two months, and is also dependent on eligibility and availability of funds.

Would you like to request up to two months of future rent?

YesNo

Requests for Future Rent

Month

Balance Due

$

Amount difference

Proof of Financial Hardship during COVID-19

What financial hardship has your household experienced during the COVID-19 pandemic? Select the option which best describes your situation.

Loss of job (was laid off or furloughed)Reduction in wages (because work hours were reduced)Reduction in business income (only choose this if self-employed)Loss of income because of COVID-19 health reasons (became ill or in high health risk category and unable to work)My household is on a fixed income, and during the COVID-19 pandemic, my household expenses increased due to personal protective equipment (gloves, masks, hand sanitizer, etc.), grocery delivery fees, or higher prices for food and other basic household goods.My household had significant expenses due to COVID-19 such as medical costs, child care and/or dependent expenses.Household has not experienced financial hardship during the COVID-19 pandemic.

Unemployment

Are you or any of your household members currently unemployed?

YesNo

If so, what date did the household member become unemployed?

Fund Delivery

If your application meets the eligibility requirements and is approved to receive a payment, please select your preferred method of payment:

Electronic Funds Transfer – payment is directly deposited into the bank account within 3-5 business days after your application is approved for paymentCertified mail-payment is mailed to your home address via certified mail, payment is received at the address provided within 10 business days after your application is approved for payment

Electronic Funds Transfer

Please note: If you enter a prepaid account, be aware that your bank or financial institution may charge fees and/or use these funds to cover any negative balances on your account.

First Name of Account Holder

Last Name of Account Holder

Name of Bank/Financial Institution

Account Type

Routing Number

Confirm Routing Number

Routing #

Account Number

Confirm Account Number

Account #

I understand that I will be receiving an ACH to the bank account provided

I understand that if the incorrect amount is deposited, I will have to inform the agency and return funds (if necessary)

Click here to get an example on how to find your account and routing number on a check

How to find your account and routing number on a check

You can find your routing number and account number on a voided check. Please see the example below.

Sample Check

Certified Mail Payment

A check will be mailed to your address.

Tenant Certification and Signature

You must check ALL of the following in order to successfully submit this application.

I certify that I am currently living in the rental property/unit at the address identified above and that I use this property for residential purposes. I understand that any assistance provided by the Program is for the purpose of paying rent.

I certify that except for the balance of past due rent, I am in good standing without any current defaults (monetary or nonmonetary) with my landlord.

I certify that the amount requested is not covered by a monthly federal housing subsidy (housing voucher, public housing, or project-based rental assistance).

I certify that I have not received previous rental assistance for any of the months requested in the application above. I understand that any assistance that is determined to be duplicative must be repaid.

I certify that I am not a participant in or received assistance through the City’s Hurricane Harvey Disaster Case Management Temporary Relocation Assistance Program (“Hurricane Harvey Assistance Program”).

I certify that all of the information and certifications listed above are correct and true and I understand that if I provide false information, all funds paid to me from the Program will have to be returned and I may be subject to further legal action.

Connective Texts

Would you like to sign up to receive text messages updates about resources like food and free mental health services through the Connective Texts program?

YesNoNote: Standard text message rates from your mobile carrier may apply.

Are you willing to share your story through news or social media?

YesNoNote: Your answer to this will not impact your ability to get assistance.

If Other, Please explain

Please type your name below to serve as your electronic signature.

If you have technical issues with the website or application form, please email helpwithrent@bakerripley.org.

Tenant Program Eligibility

City & CountyCounty OnlyCity OnlyNot Eligible

Form Language