Emergency Funding Application

EMERGENCY RENTAL ASSISTANCE PROGRAM

Only fully completed applications will be accepted.
The incomes of all adult household members 18 years of age and older are counted as a part of the application.

This is the initial application. In order to participate in this program, you must provide all of the required documents (requested at a later time) to our office. You may also have to complete a more detailed application. BCEH staff will review your application and documents to determine if your application is complete. Staff acceptance of the application does not constitute approval or guarantee participation in the program.

  • Only one application per household should be submitted.
  • Do not submit duplicate applications.

Program Guidelines:

  • Completeness of the application is crucial to establish qualifications.
  • The program is designed to benefit low to moderate income households. Some of those
    households were impacted by COVID-19.
  • The program is not first come/first served. Assistance will be prioritized based on
    application completion and clients most at risk based on Federal Poverty Guidelines.
  • Eligible tenants will have the grant paid to the landlord or utility company directly.
  • Applicant must communicate with their landlord directly to inform them they are seeking assistance.
  • Applicants will be required to provide documentation of their income and eligibility which may include check stubs, bank statements, and/or a letter from your employer.

Program is subject to funding availability

Applicant:

Address Information:

List every person living at your residence *including youself*, and all other information requested in the prompts below:

IMPORTANT INFORMATION:

*If yes, please contact the office at 610-372-7222

Employment information will be needed for ALL adult household members that are working.

EMPLOYMENT INFORMATION: HOUSEHOLD MEMBER 1

EMPLOYMENT INFORMATION: HOUSEHOLD MEMBER 2

EMPLOYMENT INFORMATION: HOUSEHOLD MEMBER 3

Income Information

Count all information for *entire household*

Expenses Information

Documents List

These documents will be requested at a later time if you are provided with an intake appointment. Please make sure to gather all documents before attending your appointment. Applicants are required to provide requested documentation.

AUTHORIZATION TO VERIFY INFORMATION


This is authorization for the Berks Coalition to End Homelessness to verify previous or current information regarding me/us. The undersigned specifically acknowledges(s) that: verification or re-verification of any information contained in this application may be made by the Berks Coalition to End Homelessness from any source named in this application.

AGREEMENT


The undersigned understand that the intent of this application is for purposes of pre-qualifying only and does not guarantee acceptance or approval and no commitment is hereby made on the part of either the applicant or the Berks Coalition to End Homeless or the Community Development Department. We further understand that all information and documents provided with, and in association with this application, are public records and as such are subject to the State of Pennsylvania’s public record laws.

I/We certify the information provided in this application is true and correct as of the date set forth opposite my signature on this application. That any property assisted under this Program will not be used for any illegal or restricted purposes, and will be used solely as my/our principal residence.

Any intentionally false or fraudulent statement, supporting document or information will constitute cancellation of this application and liability in any legal action brought against me/us by BCEH. The Berks Coalition to End Homelessness (BCEH) is hereby authorized to verify any of the above information and to inspect the property prior to approval. I/we agree to have no claim for defamation, violation of privacy or other claims against any person, firm or corporation by reason of any statement or information released by them to the Berks Coalition to End Homelessness.

 

Household Composition What I need to provide
Applicant - ID and Social Security Card
- Last 30 days of pay stubs and / or Determination
letter from the Department of labor
Adults living in the home- ID and Social Security Card
- Last 30 days of pay stubs and / or Determination
letter from the Department of labor
Children living in the home- Social Security and Birth Certificate