Catholic Rent Assistance

Rent assistance request

Complete all sections below. Your answers are saved automatically in this browser (including after refresh) until you submit successfully. Required fields are validated before we record your application.

Personal Information

How we can respectfully contact you regarding your request.

Full Legal Name

Phone

Preferred Contact Method (optional)

Address

Street

Apartment / Unit

City

State

ZIP Code

Parish Membership

Parish / Church Name

Registered Member Status

Length of Attendance

Rent Assistance Details

Monthly Rent

Amount Past Due

Months Behind

Landlord Name

Landlord Contact

Housing Hardship Description

Household

Household Size

Dependents

Special Circumstances

Additional Notes

Optional notes or prayer requests.

Notes / Prayer Requests

Step before submission

Final review & submit

Confirm the information above is accurate to the best of your knowledge. When you submit, your request is recorded for confidential review. You will receive a reference number on the next screen—please save it for follow-up calls or email.

Application readiness

0%Complete the highlighted sections above — the checklist shows what is still needed.

Your information is transmitted securely and reviewed only by authorized Catholic Charitable Rent Relief staff. It is used solely to consider assistance and coordinate follow-up.

Section checklist

Personal information
Address
Parish membership
Rent assistance details
Household
Additional notes(optional)

By submitting, you confirm that the information provided is accurate to the best of your knowledge. If you need help with this form, contact intake@catholiccharitablerentrelief.example.

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