Housing Deposit Assistance Information Form

CROSSROADS MINISTRY of ESTES PARK, INC. IS CONSIDERING A RENTAL ASSISTANCE GRANT TO HELP TENENAT LISTED BELOW TO MEET RENTAL OBLIGATIONS.

In order to process the grant, Crossroads of Estes Park requires the information below. This form with affixed signatures must be returned within seven (7) days or it will be null and void. Upon successful and timely completion of this form, Crossroads of Estes Park will write a voucher for the amount of the grant. A check will then be written within 10 working days and either mailed to the address listed below or left in the Crossroads of Estes Park office, as indicated below.

OWNER OR PROPERTY MANAGER INFORMATION

(Name to whom the check should be made out)

Property Owner/Manager First Name:

Property Owner/Manager Last Name:

Property Owner/Manager Phone:

Mail Payment to (Name, Street, City):

TENANT INFORMATION

Tenant Full Name:

Tenant Phone:

Street Address of Rental Unit

Amount required by contract:

Deposit $

1st Month Rent

Date Due by:

Grant amount approved:

Grant Amount $

Please Attach Copy of Lease

Date

Month

Day

Year

Signature of Tenant Requesting Assistance

Signature field is empty.

Crossroads
Housing Deposit Assistance Information Form

Building Lasting Relationships

Housing Deposit Assistance Information Form

Amount required by contract:

Grant amount approved:

Crossroads Housing Deposit Assistance Information Form

Crossroads
Housing Deposit Assistance Information Form