Section 1 of 3 in this document

Chatham County Emergency Rental Assistance Program Pre-application form

To be eligible, you must meet the following eligibility criteria and provide proof of it:

Place of residence must be within Chatham County;
Place of residence must be a rental property, single or multi-family home, or mobile home;
Must be able to demonstrate that one or more individuals within the household is at risk of experiencing homelessness, housing instability or eviction;

Your household income does not exceed 80% of the Area Median Income (AMI)

Table 1 - Maximum Income Limits for Renters - 80%
Number of person in the household	1	2	3	4	5	6	7	8
Maximum annual income limits	$46,700	$53,400	$60,050	$66,700	$72,050	$77,400	$82,750	$88,050
Maxmum monthly income limits	$3,891.66	$4,450.00	$5,041.67	$5,558.33	$6,004.16	$6,450.00	$6,895.83	$7,337.50

One or more individuals in the household has qualified for unemployment benefits after March 13, 2020, or experienced a loss of income, or other financial hardship due, directly, or indirectly to COVID-19.
Your household has not received or will not receive any other assistance for the same expenses. Duplicate assistance is not permitted.

Please prepare the documentation and upload them at the end of the questionnaire, or provide them to the agent assigned to your case (check the links below):

Tenant (chathamerap.org)

Landlord (chathamerap.org)

Your application will be processed more quickly if you can provide the required documentation at the time you submit this form.

FAQ (chathamerap.org)

WARNING!

In signing this document (including electronic signature), you are acknowledging that falsification of documents or any material falsehoods or omissions in the Application, including knowingly seeking duplicative benefits, is subject to state and federal criminal penalties. You are particularly put on notice that the Title 18, Section 1001 of the U.S. Code, provides among other things, that whoever knowingly and willingly makes or uses a document or writing containing any false, fictitious, or fraudulent statement or entry, in any matter within the jurisdiction of any department or agency of the United States will be fined not more than $10,000 or imprisoned for not more than five years, or both.

Pre-application Form #

You will be provided with a Pre-application Form # upon submission.

Do you live in Chatham County?

Yes

We are sorry! You are not eligible for the Chatham County Emergency Rental Assistance Program.

Type of applicant:

Tenant

Landlord (on behalf of Tenant)

Do you have an open application with other Service Provider and/or have been assisted before by another Service Provider? If so, please indicate the Organization's name:

Yes

Unsure

Indicate the name of the Service Provider (non-profit Organization):

Landlord Full Name or Company Name

Landlord Email Address

Landlord Phone Number

Phone Number

Gender

Female

Male

Nonbinary

Other

Declined to answer

Race - Ethnicity

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Hispanic or Latino

Multi-racial

Other

Declined to answer

Number of Household Members

Is the household income less than the 80% of the Area Median Income based on table 1 (A household is everyone living in your home, including you).

Yes

We are sorry! You are not eligible for the Chatham County Emergency Rental Assistance Program.

What was your household's annual income in 2021? (Your household annual income is the total of what everyone in your household over age 18 earned in 2021)

Are you or your household required to pay rent and/or utilities?

Yes

We are sorry! You are not eligible for the Chatham County Emergency Rental Assistance Program.

Have one or more individuals within the household qualified for unemployment benefits or experienced a reduction in household income, incurred significant costs, or experienced other financial hardship due, during, directly or indirectly, to the COVID-19 outbreak?

Yes

We are sorry! You are not eligible for the Chatham County Emergency Rental Assistance Program.

Can one or more individuals residing within the household demonstrate a risk of experiencing homelessness or housing instability including a past due utility or rent notice or an eviction notice, unsafe or unhealthy living conditions, or any other evidence of risk?

Yes

We are sorry! You are not eligible for the Chatham County Emergency Rental Assistance Program.

Do you have an eviction notice? If yes, please indicate the court date and upload the document in order to prioritize your application.

Yes

Unsure

Court date:

You are eligible! Please upload the documentation and submit the form, one of our Service Providers will contact you to complete the application. If you are unable to upload the documentation, please submit and print this form and present it with the documents to the agent that will be assigned to your case. Thank you.

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Section 2 of 3 in this document

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Chatham County Emergency Rental Assistance Program Pre-application form

Pre-application Form #

Do you live in Chatham County?

Type of applicant:

Do you have an open application with other Service Provider and/or have been assisted before by another Service Provider? If so, please indicate the Organization's name:

Tenant Full Name

Full Address

Gender

Race - Ethnicity

Is the household income less than the 80% of the Area Median Income based on table 1 (A household is everyone living in your home, including you).

Are you or your household required to pay rent and/or utilities?

Have one or more individuals within the household qualified for unemployment benefits or experienced a reduction in household income, incurred significant costs, or experienced other financial hardship due, during, directly or indirectly, to the COVID-19 outbreak?

Can one or more individuals residing within the household demonstrate a risk of experiencing homelessness or housing instability including a past due utility or rent notice or an eviction notice, unsafe or unhealthy living conditions, or any other evidence of risk?

Do you have an eviction notice? If yes, please indicate the court date and upload the document in order to prioritize your application.

Upload File(s)

Sign Here