Hotel/Motel Voucher & Rent/Mortgage Assistance Registration FormName Contact No. Email Address (where being evicted) Number of Family Members Evicted - Select -123456789101112131415Provided Eviction Notice (yes/no) - Select -YesNoName of Landlord Landlord's Contact No. Current Employment Status - Select -EmployedUnemployedPart-timerName of Company (if employed) Position Rent Assistance Requirements Provided Assistance Requested (Hotel/Motel Voucher or Rent/Mortgage Assistance) - Select -Hotel/Motel VoucherRent/Mortgage AssistanceCase Manager Submit Form
