Rental Assistance

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FAMILY RESOURCE HUB

https://www.wmata.com/service/status/details/C OVID-

19.cfm?mc_cid=042dccbd7c&mc_eid=1134e87b6

http://assumptiondc.org/outreach/ outreach@assumptiondc.org

https://dcfoodproject.org/emergency-foodaccess

https://www.capitalareafoodbank.org/covid1 9response/

file:///C:/Users/tbrooks/AppData/Local/Microsoft/Wi ndows/INetCache/Content.Outlook/135NP9KC/COVI D-19%20Day%20ProgramMeal%20Program%20Flyer_2020_03_20.pdf

Far Southeast Collaborative INTAKE

Edgewood Brooklyn Family Support Collaborative

Ft. Stanton Rec

DC Dream Center

DC Dream Center next to Pope Funeral Home

3917 Minnesota Ave NE WDC 20019

2041 MLK Ave SE #304 WDC 20020

http://ebfsc.org/

https://marthastable.org/programs/foodaccessprogra ms/

Q St SE https://dcdreamcenter.com/

DC Dream Center at Francis Gregory Library 2617 Pennsylvania Ave SE 3660 Alabama Ave SE Thursday 11-12noon Saturday 11- 12noon

Families Moving Forward Food Pantry

PLEASE SEE ALSO

• d.c. Central Kitchen Healthy Corners

• Ward 7 Food Resource Guide

• Ward 8 Food Resource Guide

Rhode Island Ave NE (Corner of 20th & Rhode Island

https://marthastable.org/programs/foodaccesspr

cnicholas@dcc entralkitchen.o rg https://dccentralkitchen.org/healthy-corners/

UTILITIES Name Phon

Verizon implemented its “Promise to Pay” program, allowing federal employees and other affected workers to set a future date to pay their wireless or cellphone bill. Late fees and agent assistance fees are waived for as long as the shutdown lasts

AT&T will waive late fees, provide extensions, and coordinate with you on revised payment schedules.

Customers who are Federal government employees and need short-term account assistance can work with T-Mobile Customer Care representatives on solutions tailored to meet their needs, including flexible payment options that allow customers to spread their service payments over time. Payment deferral is also an option. T-Mobile is offering the same support to government account customers.

https://webserver1.dchousing.org/

https://dhs.dc.gov/service/emergencyrental-assistance-program

https://www.communityofhopedc.org/healthcare/e motional-wellness

https://www.cdc.gov/coronavirus/2019ncov/prepare/managing-stress-anxiety.html

https://www.amazon.com/b?ie=UT F8&node=16256994011

Amazon Prime offers a discounted monthly fee for household that receive EBT or Medicaid. Monthly fee of $5.99 a month! Amazon

https://stories.audible.com/startlisten

Amazon canceled the subscription fees of books and audio stories for children and students of all ages as long as schools are closed, kids everywhere can instantly stream an incredible collection of stories, including titles across six different languages, that will help them continue streaming, learning, and just being kids.

All stories are free to stream on your desktop, laptop, phone or tablet

COVID-19 Quarantine: Virtual Events for Kids https://www.facebook.com/groups /virtualeventsforkids/

COVID-19 Distance Learning file:///C:/Users/tbrooks/AppData/L ocal/Microsoft/Windows/INetCache /Content.Outlook/135NP9KC/Coro navirus%20COVID19%20Resources%20CASD%20Cha t.pdf

https://mdfoodbank.org/find-food/

211 MD - Food Pantry Listings: https://211md.org/211provider-md-search-results?q=Food%20Pantries

Catholic Charities - Food Pantries & Soup Kitchens in each county: http://www.catholiccharitiesmd.org/wpcontent/uploads/2017/08/food-pantries-in-mdpdf-1.pdf

Anne Arundel County

Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Anne Arundel County Government - Resource list: https://www.aacounty.org/boards-and-commissions/partnership-forchildren-youth-families/forms-andpublications/2018-aaco-partnerhsip-resource-list.pdf

Baltimore City Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

St. Vincent DePaul https://www.vincentbaltimore.org/hunger

Baltimore County Community Resources Guide - page 106 http://resources.baltimorecountymd.gov/Documents/Aging/communityres2018.pdf

Calvert County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

End Hunger in Calvert County https://endhungercalvert.org/

Caroline County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Carroll County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Cecil County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Dorchester County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Frederick County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Food pantries in Frederick County https://www.foodpantries.org/ci/md-frederick

Community Action Agency - 3 - 5 day supply of food www.cityoffrederick.com

Religious Coalition for Emergency Human Needs https://www.thereligiouscoalition.org/programs-services/food-banks/

Middletown Food Bank - Middletown, MD - Food Assistance 301 E Main St, Middletown, MD 21769 (301) 371-3182

Bread of Life Community Kitchen - Soup Kitchen and Food Boxes Frederick, MD 21701 www.therescuemission.org

Glade Valley Community Services Food Bank and Share Food Network Walkersville, MD 21793 View Details Frederick County

https://www.frederickcountymd.gov/7815/Federal-Government-Shutdown-Assistance

Garrett County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

My Garrett County - Food Availability Brochure: https://mygarrettcounty.com/?get_group_doc=194/1519590690FoodAvailabilityBrochure2018.pdf

Harford County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Harford County Department of Community Services - Resource Guide/List of Food Pantries: http://www.harfordcountymd.gov/DocumentCenter/View/12038/Resource-Guide---online-version

Howard County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Community Action Council of Howard County - Howard County Food Bank and Partners: https://www.cachc.org/wpcontent/uploads/Pantry-and-Partners-2019.pdf

Kent County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Kent County Government - List of food & nutrition services: https://www.kentcounty.com/resource-directory/foodnutrition

Angel Food Ministries- Angel Food box for $30. No income qualifications. Orders must be placed in advance First United Methodist Church- 105 N. Mill Street, Chestertown, MD

Rev. Rick Vance- 410-778-2977

Rock Hall United Methodist Church 6190 Rock Hall Rd, Rock Hall, MD Rev. Linda Mariner- 410-639-7206 Food is distributed the third Saturday of every month at the Rock Hall Church

Wesley Chapel United Methodist Church 5920 Williams Street, Rock Hall, MD Contact Frank Shirley- 410-639-7277 Food is distributed the second Wednesday of every month at the church

Montgomery County Government - Federal Shutdown Assistance Portal https://montgomerycountymd.gov/mcg/fed_employee-furlough.html

Manna Food Center - Distribution Sites http://www.mannafood.org/about/contact-manna/manna-food-distributionsites/

Gaithersburg HELP https://www.gaithersburghelp.org/get-help/food/

Nourish Now - Get Food https://nourishnow.org/get-food/

EMERGENCY FOOD ASSISTANCE For residents currently experiencing a food deficit, PGCDSS hosts Mission Nutrition, a community based mobile food market. A list of distribution dates and locations can be found online at https://www.princegeorgescountymd.gov/DocumentCenter/View/24277/2019-Mission-Nutrition-Dates-

Locations. The Capital Area Food Bank (CAFB) also operates community marketplaces and distribution details can be found online at https://www.capitalareafoodbank.org/community-marketplaces-2/. Finally, the CAFB acts as a clearinghouse for the distribution of donated food in the washington metropolitan area and more than 60 County based pantries participate in the program. Food is provided by those pantries to eligible individuals and families free of charge and if you need assistance locating a pantry near your home, please contact 311.

Queen Anne's County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Haven Ministries https://haven-ministries.org/how-haven-helps/haven-ministries-emergency-food-pantry/

Somerset County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

St.Mary's County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Lexington Park Food Pantries https://www.suntopia.org/lexington_park/md/food_pantries.php

Our Daily Bread Food Pantry http://www.goodsam.community/our-daily-bread-food-pantry/

Southern Maryland Food Bank https://southernmarylandfoodbank.com/

St. Mary’s Caring http://stmaryscaring.org/

Talbot County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Washington County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

United Way Washington County Food Pantries

http://www.unitedwaywashcounty.org/sites/unitedwaywashcounty.org/files/Food%20and%20Clothing%20R esources%20updated%206272017.pdf

The Joseph House Food Pantry https://thejosephhouse.org/if-you-need-help/

Haven Ministries Emergency Food Pantry https://haven-ministries.org/how-haven-helps/haven-ministries-emergencyfood-pantry/

Wicomico County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

Worcester County Maryland Food Bank - Find Food Bank Near Me: https://mdfoodbank.org/find-food/

New Jerusalem Holy Church: P.A.C.A Food Pantry

http://worcester.md.networkofcare.org/mh/services/agency.aspx?pid=NewJerusalemHolyChurchPACAFood Pantry_214_2_0

The Samaritan Shelter Food Programs http://www.thesamaritanshelter.org/About-Us/about-us.html#Programs

Emergency Rental Assistance Program (ERAP)

What is ERAP?

The Emergency Rental Assistance Program (ERAP) helps low-income, District residents who are facing housing emergencies. A housing emergency is when immediate action is needed to avoid homelessness, to reestablish a home, or to prevent eviction from a home.

How can ERAP help?

ERAP can help to pay the following:

• Overdue rent, including late costs and court fees, if eviction is about to happen

• Security deposit for a new residence

• First month’s rent

ERAP cannot help to pay for utilities, mortgage payments, or any housing expense other than those listed above.

Who is eligible for ERAP?

You must be a resident of DC, and your income must be below 125% of the monthly federal poverty level according to household size.

Will ERAP pay all of the rent arrearages or security deposit?

When you apply for ERAP, we will look at your income and resources. If you are eligible we will tell you how much you should pay and how much ERAP will pay.

Are there limits on how much ERAP can pay?

ERAP can only pay up to certain limits. For overdue rent, ERAP can pay for up to 5 months of overdue rent, or $4,250. (In cases of disability or households with seven or more children, this can be increased to up to

$6,000 ) For security deposits and the first month’s rent, ERAP can pay up to a total of $900 each.

If paying the highest ERAP amount will not take care of the housing emergency, ERAP cannot make its payment until you show how the remainder of the needed money will be paid. Also, you can only receive help from ERAP once in a twelve month period.

Will ERAP give me the money directly?

ERAP will make its payment directly to the landlord, court, or court marshals. No money will be given to you directly.

How do I apply for ERAP?

Six (6) organizations will be taking applications for ERAP. Their names, addresses, and telephone numbers are listed on the reverse side of this form. You must fill out an application, be interviewed, and provide documents the organization needs to decide if you are eligible. If you do not have enough resources to pay for the residence after the immediate emergency is taken care of, you must also agree to take part in case management services. This will help make sure another housing emergency does not happen. For general ERAP inquiries, please email: erap.program@dc.gov

GOVERNMENT OF THE DISTRICT OF COLUMBIA

D

EPARTMENT OF HUMAN SERVICES

You may request an ERAP appointment at the following locations:

Catholic Charities

The Southeast Family Center

2812 Pennsylvania Avenue, SE, Washington, D.C., 20020

Office (202) 338-3100, or Fax (202) 338-3188 Website: www.catholiccharitiesdc.org

Call-in for appointments:1st and 3rd Monday of the month 9 am – 11am

Those with WRITs: Call Monday – Friday to check availability (Six [6] customers per week)

Housing Counseling Services, Inc.

2410 17th Street, NW, Suite 100, Washington, D.C., 20009

Adams Alley (between Euclid and Kalorama Streets) Office (202) 667-7006, or Fax (202) 667-1267 Website: www.Housingetc.org

ERAP Recorded Information Line: (202) 667-7339

(Appointments Only: Call 9-5 on the first business day of each month at (202) 667-7339)

Salvation Army (NW Office)

National Capital Area Command 1434 Harvard St, NW Suite B, Washington, D.C., 20009

Office: (202) 332-5000, or Fax (202) 332-5156 Website: www.salvationarmynca.org

(Call in for appointments on 2nd and 4th Monday of the month. WRIT walk- in every Thursday)

Salvation Army (SE office)

The Solomon G. Brown Social Services Center

2300 Martin Luther King, Jr. Avenue, SE, Washington, D.C., 20020 Office (202) 678-9771, or Fax (202) 889-8492

(Call in for appointments on 2nd and 4th Friday of the month) WRIT walk- in every Wednesday)

The Community Partnership for The Prevention Of Homelessness (TCP) at Virginia Williams Family Resource Center

920 Rhode Island Avenue NE Washington, D C., 20018 Office (202) 312-5510, or Fax (202) 312-5598 Website: www.community-partnership.org

(Appointments are scheduled on the 3rd Wednesday of each month starting at 8am by phone call only. WRIT Walk-in Monday and Tuesday first 10 clients each day)

United Planning Organization (UPO)

2907 Martin Luther King Jr. Avenue, SE, Washington, DC 20032

Fax (202) 562-3802 Website: www.upo.org

ERAP Scheduling (202) 231-7922

Greater Washington Urban League

2901 14th Street, NW, Washington, D.C., 20009

Office: (202) 265-8200, or Fax (202) 387-6515: Website: www.gwul.org

(Call in for appointments 3rd Monday of the month. WRIT walk-in on Thursday)

“If you need help in any way at House of Ruth, they will try their best to assist you. You can talk to any staff member, any case manager, about what’s going on in your life, and they will listen and help."

“I came to House of Ruth two years ago. While I was checking in, I didn’t have a job, I didn’t know where I was supposed to start, and I was pretty much all over the place. The case workers were a big help to me, directing me to different programs and resources to find a job, workshops and women’s groups to attend. It was a big help to me to get where I’m at today. I’m so grateful for House of Ruth and its place in my life."

Kira

“I am a beneficiary of House of Ruth’s Homes for Women Program. I lived at one of their facilities for 13 months. My case worker, and the other staff, assisted me with navigating a lot of Social Services red tape, saving my money (so I would be ready when housing became available), referring me to outside housing agencies for consideration, making sure I was healthy (mentally and physically), and a WHOLE lot of other things too numerous to mention."

“House of Ruth did so much more than provide me with a safe place to stay. In the 18 months I worked with them, they gave me counseling to help with my own

mental issues that I had going on at the time, got me grants, and helped me fix my credit. We are now in our own apartment.“

Janice

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Rental Assistance

• Catholic Charities SE Family Center (FEMA funds) Wards 6&7 (202) 519-3383-(202) 996-0630

• Greater Washington Urban League -202-265-8200 or (202) 529-8701

• The Community Partnership (202) 312-5510

• The United Planning Organization (202) 562-3800

The Modern at Art Place

Subsidized and Low-Income Apartment Buildings

Updated: November 8, 2021

** CALL FOR AVAILABILITY AND INFORMATION **

https://www.themoderndc.com/housing-for-all/

400 Galloway Street NE, Washington DC 20011

833-728-5688

Affordable Dwelling Unit Program

Park 7 Apartments

https://www.park7dc.com/

4020 Minnesota Avenue NE, Washington DC 20019

877-958-9880

Affordable Dwelling Unit Program

Solstice DC Apartments

https://www.solsticedc.com/affordable-living-options

3534 Eat Capitol St. NE, Washington DC 20019

202-567-6880

Affordable Dwelling Unit Program

1330 Apartments

https://1330apartments.enterpriseresidential.org/

1330 7th Street NW, Washington DC 20001

202-387-7558

Affordable Dwelling Unit Program

Azeeze Bates

Website unavailable

1521 F Street NE, Washington DC 20002

202-396-2512

HUD Subsidized Housing

Benning Courts

Website unavailable

1703 Benning Road NE, Washington DC 20002

202-396-2512

HUD Subsidized Housing

Benning Heights

https://www.winncompanies.com/washington/benning-heights/ 4806 Alabama Avenue SE, Unit B, Washington DC 20019

202-583-0454

HUD Subsidized Housing

Benning Park Apartments

Website unavailable

5113 Fitch Street SE Washington DC 20019

202-582-2100

HUD Subsidized Housing

Benning Road Apartments

Website Unavailable

4625 Benning Road SE Suite C, Washington DC 20019

202-581-1633

HUD Subsidized Housing

Brookland Manor (Brentwood Village)

Website unavailable

2413 14th Street NE, Washington DC 20018 (202) 529-3150

HUD Subsidized Housing

Capitol Commons

Website unavailable

4202 13 Street NW, Washington DC 20011

202-543-1890

HUD Subsidized Housing- Disabled, low-income housing

Carmel Plaza North

Website unavailable

200 K Street NW, Washington DC 20001

202-898-0660

HUD Subsidized Housing

Carver Hall Apartments

Website unavailable

2338 Pitts Place SE, Washington DC 20020

202-678-3888

HUD Subsidized Housing

Claypoole Courts Apartments

https://www.horningbrothers.com/claypoole-courts-apartments/ 1445 Fairmont Street NW, Washington DC 20009

202-332-1628

HUD Subsidized Housing

Columbia Heights Village Apartments

https://nhpfoundation.org/property/columbia-heights-village-apartments/

2900 14th Street NW, Washington DC 20009

202-234-6900

HUD Subsidized Housing

Congress Park I & II

Website unavailable 1345 Savannah Street SE, Washington DC 20032

202-574-4633

HUD Subsidized Housing

Covington Family Association Inc.

Website unavailable

1848 Columbia Road NW, Washington DC 20009

202-291-5050

HUD Subsidized Housing

Elsinore Courtyard Apartments

Website unavailable

5312 E Street SE, Washington DC 20019

202-869-0082

Affordable Dwelling Unit Program

Faircliff Plaza East

https://www.faircliffplazaeastapts.com/ 1350 Fairmont Street NW, Washington DC 20009

202-652-0290

Habitat America community, low-income housing

Fiarcliff Plaza West

https://www.faircliffplazawestapts.com/ 1428 Clifton Street NW, Washington DC 20009

202-986-2802

Habitat America community, low-income housing

Fairlawn Marshall Apartments

https://www.fairlawnmarshallapartments.com/

2834 Q Street SE, Washington DC 20020

202-584-5364

Affordable Dwelling Unit Program

Fairmont Apartments

https://www.livefairmont.com/ 1401 Fairmont Street NW, Washington DC 20009

202-232-6440

HUD Subsidized Housing

Forest Ridge/The Vistas Apartments

Website unavailable

2549 Elvans Road SE, Washington DC 20020

202-878-8203

HUD Subsidized Housing

Frederick Douglass Apartments

https://www.edgewoodmgmt.com/apartments/dc/washington/frederick-douglass/

1438 Cedar Street SE, Washington DC 20020

202-559-7240

Affordable Dwelling Unit Program and HUD Subsidized Housing

Garfield Hills

https://www.garfieldhills.com/ 2317 Hartford Street, Washington DC 20020

202-889-0030

Affordable Dwelling Unit Program

Henson Ridge Apartments

https://www.edgewoodmgmt.com/apartments/dc/washington/henson-ridge/ 1804 Alabama Avenue SE, Washington DC 20020

202-888-0915

Affordable Dwelling Unit Program

Hubbard Place

https://www.habitatamerica.com/communities/hubbard-place/ 3500 14th Street NW, Washington DC 20010

202-387-7722

Habitat America community, low-income housing

Huntington Village

Website Unavailable

3526 Stanton Road SE, Washington DC 20020

202-889-0804

HUD Subsidized Housing

King Towers

https://www.edgewoodmgmt.com/apartments/dc/washington/king-towers/ 1220 12th Street NW, Washington DC 20005

202-289-3897

Affordable Dwelling Unit Program and HUD Subsidized Housing

Mayfair Mansions

https://mayfairmansions.enterpriseresidential.org/ 3744 ½ Hayes Street NE, Washington DC 20019

202-396-9100

Affordable Dwelling Unit Program

Oak Street Apartments

Website Unavailable 1456 Oak Street NW, Washington DC 20010

202-483-9100

HUD Subsidized Housing

202Assist - Rental Assistance Program

COVID-19 Tenant Based Rental Assistance – Tenant Application

Please answer all the questions on this form to the bests of your ability. If a question does not apply, please write N/A SUPPORTING DOCUMENTS

Supporting Documentation Checklist:

1. Evidence of income for every adult for the 60 days prior to application.

2. Evidence of loss of income per wage earner

3. Self-certification for all income or emergency benefits received per wage earner.

4. Personal Identification (ID and birth certificate) for all household members.

5. Your most recent lease

6. Signed release of information Provided.

If you are unable to provide any of the required documents, please explain why:

Applicant Full Name: Application Date:

Provided: ☐Yes ☐ No

Provided: ☐Yes ☐ No

Provided: ☐Yes ☐ No

Provided: ☐Yes ☐ No

Provided: ☐Yes ☐ No

Provided: ☐Yes ☐ No

Applicant Email: Applicant Phone Number:

Applicant Address: Unit #

Describe why you need rental assistance:

Race of Applicant (Optional). Please check the options that apply: ☐ White ☐ Black/African American ☐ Asian ☐ American Indian/Alaskan Native ☐Native Hawaiian/ Other Pacific Islander ☐American Indian/Alaskan Native & White ☐ Asian & White ☐Black/African American & White ☐ American Indian/Alaskan Native & Black/African American ☐ Other Multiracial ☐ Declined to answer

Ethnicity of Applicant (Optional). Please check options that apply: Hispanic/Latino ☐ Yes ☐ No ☐ Declined to answer

Household Description (Optional). Please check the options that apply: ☐Single/ Non-elderly ☐Elderly (62+ years) ☐ Single Parent ☐ Two Parent ☐ Other

HOUSEHOLD INFORMATION: List all members who reside in the unit and note their relationship to the applicant. FULL NAME DATE OF BIRTH RELATIONSHIP Is this person disabled? (√)

RENTAL INFORMATION

Household Size (Number of persons residing in unit):

Unit Size: ☐ Efficiency ☐ One Bedroom ☐ Two Bedroom ☐ Three Bedroom

202Assist - Rental Assistance Program

Please provide a copy of your lease and information on current rent charged and owed: Lease Provided ☐ Yes ☐ No Current Rent: How much of Back Rent do you owe? Are you about to be evicted from your housing? ☐ Yes ☐ No If yes, please explain:

Have you received any Rental Assistance in the past 12 months? ☐ Yes ☐ No If so, what type of assistance?

EMPLOYMENT INFORMATION

Did you lose income since March 13, 2020? ☐ Yes ☐ No If yes, are you eligible for unemployment? ☐ Yes ☐ No

Have you voluntarily left a job or refused to accept employment or training within the past 3 months? ☐ Yes ☐ No If yes, why?

MEMBER'S FULL NAME SOURCE

Annual gross income (total of all members)

May we contact your employers to verify employment? ☐ Yes ☐ No If no, why not?

Please provide a point of contact and contact information: Have you lost income since March 13, 2020? ☐ Yes ☐ No If yes, check all that apply: ☐Furloughed ☐Laid off ☐ Hours reduced ☐ Fired ☐ Business closed permanently ☐ Self-employment income reduced ☐ other (explain):

Are you eligible for unemployment? ☐ Yes ☐ No

Please explain how the health emergency has affected your ability to pay rent: What was your gross annual income prior to March 13 2020?

BUILDING INFORMATION

Address: Zip Code: Ward:

Name of Building:

Type of building: ☐Rental ☐ Co-op

Name of Property Owner/Management Company:

Phone Number: Email Address:

Name of Property Manager/Point of Contact:

ASSET INFORMATION

202Assist - Rental Assistance Program

List the type and source of household assets and provide the current cash value and the estimated annual income from each. MEMBER'S FULL NAME TYPE & SOURCE OF ASSET CASH VALUE ANNUAL INCOME FROM ASSET

APPLICATION CERTIFICATION (can be emailed by applicant)

I certify that the above information is true to my knowledge at the time of application.

Applicant Name:

Applicant Signature:

Authorization and Release

Date:

I ___________________________authorize Lydia’s House in Southeast and/or program partners to: (a) generate my credit report to review my credit file for housing counseling in connection with my pursuit of rental assistance should it be deemed necessary by Lydia’s House in Southeast and/or program partners. I authorize Lydia’s House in Southeast (LH) and/or program partners to: (c) report and share statistical and demographic information from my file with its representatives and program partners as deemed necessary.

Applicant Name:

Applicant Signature:

Date:

Applicant indicates that he/she is unable to submit a signed document because of lack of necessary technology. Information in this application was reviewed with applicant and orally confirmed by program staff:

Program Staff Name:

Staff Signature: _ Date:

Warning: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to willfully falsify a material fact or make a false statement in any matter within the jurisdiction of a federal agency.

This certification and any attachments are made under penalty of perjury. Failure to complete this form in its entirety will result in noncompliance with program regulations. In addition, any individual other than an owner or general partner of the project is not permitted to sign this form, unless so permitted.

Email Completed form to LHAdmin@lhndc.org and attach Rental Assistance Application

The subject line for the email should be titled – “202Assist – Last Name – 2021234567” (phone number)

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EDUCARE DC, A HEAD START PROVIDER, IS MORE THAN JUST A DAYCARE OR CHILDCARE PROGRAM WE ARE YOUR PARTNER FOR PREPARING YOUR CHILD FOR SUCCESS IN SCHOOL AND LIFE. SAFE, FUN, AND CHALLENGING, EDUCARE UNLEASHES YOUR CHILD’S CURIOSITY TO BUILD A LIFETIME LOVE OF LEARNING PROVIDING THE HIGHEST QUALITY CARE AND EDUCATION TO FAMILIES.

PARKSIDE: 640 ANACOSTIA AVE. NE | WASHINGTON, DC 20019 | 202-727-5604 IDEA: 4501 LEE ST. NE | WASHINGTON, DC 2001

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