donotreply@auroragov.org
15151 E Alameda Pkwy, Aurora, CO, 80012, US
303-739-7000
Documents to Upload
These will complete the application
If you are unable to pay rent due to loss of income related to COVID-19 and you feel that you qualify please complete this application.
You will need to have all your documents ready to submit.
Receipt Number
Preferred Language
Address
Is this household member disabled?
Are you a veteran?
Race (Check all that apply)
For the purposes of this application - "Hispanic or Latino" - is a person of Cuban, Mexican, Puerto Rican, South or Central America or other Spanish culture/origin, regardless of race. The term, "Spanish origin", can also be used.
*This information is being collected to ensure compliance with demographic reporting requirements.
Are there people age of 17 and younger?
Do you have a voucher
Voucher Type
If you checked any of the above: Have you contacted your Housing Authority to readjust your rent amount?
If you do not have a voucher CONTINUE.
Loss of income due to COVID-19 after March 11, 2020?
How did you hear about this rental Program?
Are you already working with one of the following agencies regarding Rental Assistance?
Is this your first time requesting rental assistance?
Housing Type for Primary Residential unit:
Rental Home
Unit Type
Are there other adults in the household (age 18 and older)
Adult Household Member(s) (HHM) 18 and older
Adult Household Member 1 (HHM1)
Adult HHM1 Race (Check all that apply)
Adult Household Member 2 (HHM2)
Adult HHM2 Race (Check all that apply):
Adult Household Member 3 (HHM3)
Adult HHM3 Race (Check all that apply):
CHILD HOUSEHOLD MEMBERS (HHM) UNDER age 17 and under
If there are no household members age 17 and younger, please click the Next button to continue.
Child HHM1 Is this Household member disabled?
Child HHM1 Race (Check all that apply)
Child HHM2 Is this household member disabled?
Child HHM2 Race (Check all that apply):
Child HHM3 Is this household member disabled?
Child HHM3 Race (Check all that apply)
Child HHM4 Is this household member disabled?
Child HHM4 Race (Check all that apply)
Are there more children in this household?
INCOME INFORMATION (PRE-COVID-19): Income includes: Wages, salaries and tips, alimony, child support, military income, part-time income, temporary income, TANF, Social Security, other benefits, other income for all household members over the age of 18. List ALL household members and their incomes. Attach a separate sheet if you need more space, or the “Income Source” table provided and their incomes. Attach a separate sheet if you need more space or use the “income Source” table provided immediately below. FOOD STAMPS ARE NOT CONSIDERED INCOME – do not list food stamps. STIMULOUS CHECK – is not considered income
For each household member, enter first and last name and their monthly income below.
OTHER ASSISTANCE RECEIVED:
Have you received other COVID-related financial assistance? Do not include CARES ACT stimulus payment.
Applicant Certification - Certify that all information in the application is true, to the best of your knowledge. By signing this application, the applicant authorizes the City of Aurora or any of its duly authorized representatives to verify the information contained herein.
I/We understand the information provided above is collected to determine if I/We are eligible to receive assistance under the City of Aurora Emergency Housing Assistance Program for households economically impacted by COVID-19. I/We hereby certify that providing false statements or information is grounds for termination of housing assistance and is punishable under federal law. I/We authorize the City of Aurora Emergency Housing Assistance Program and any of its authorized representatives to verify all information provided in this application. I/We understand that additional information will likely be required to move forward with this program. I/We understand that I/We may be responsible to repay/return any duplicated benefits received in concert with this program or any of the other assistance received hereafter. Please sign this application below certifying that you understand and agree that you may be responsible for repaying any other benefits that are determined to be duplicated of the assistance received from this program.
Are you a US Citizen or a legal permanent resident of the United States? (Your answer to this question is confidential and will not be shared with other government entities. This information is only used to determine the funding source.)
Application prepared by:
The date this application is completed
Notice: Due to the nature of this program, and to avoid additional unnecessary contact, a typed name on this form will constitute the legal equivalent of your signature for the purposes of this application.
Warning:
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government.
Applicant Full Name
ELIGIBILITY RELEASE: It is required that you sign this form, which allows the City of Aurora to request information from Third Parties concerning your eligibility and participation in this program.
Information Covered: Inquiries may be made about items including: Income (all sources including dependent income), Assets (all sources), Child Support, Rental Amount.
Instructions to Applicant: Your signature on this Eligibility Release, and the signatures of each member of your household who is 18 years of age or older, authorizes the city of Aurora or any of its duly authorized representatives to obtain information from a third party regarding your eligibility and continued participation in the Emergency Housing Assistance Program (COVID-19).
Privacy Act Notice Statement: The City of Aurora requires the collection of the information listed in this form to determine an applicant’s eligibility for the Program. This information will be used to establish the level of benefits for which the applicant is eligible and to verify the accuracy of the information furnished. information received from an applicant or as a result of verifying the applicant’s eligibility may be released to appropriate Federal, State, and Local government and local agencies, or when relevant, to civil, criminal, or regulatory investigators, and to prosecutors, Failure to provide any information may result in delay or rejection of your eligibility approval. Subrecipient is authorized to ask for this information under the National Affordable Housing Act of 1990.
NOTE: THIS GENERAL CONSENT MAY NOT BE USED TO REQUEST A COPY OF A TAX RETURN.
Applicant’s Authorization:
I authorize the above-named Nonprofit, State or Local Government or Vendor to obtain information about me and my household that is pertinent to determining my eligibility for participation in the Program, I acknowledge that: (1) A photocopy of this form is valid as the original; AND (2) My printed name will act in lieu of a written signature for the purposes of this form: AND (3) I have the right to review information received using this form; AND (4) I have the right to a copy of information provided to the Subrecipient and to request correction of any information I believe to be inaccurate; AND (5) All adult household members will sign this form and cooperate with the subrecipient in the eligibility verification process.
WARNING: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government.
Electronic Signature of Head of Household:
Application Signed by Agency
If the application isn’t allowing you to upload, please contact
COA-Rentassist@auroragov.org
Upload Lease Agreement
Upload Late Rent Notice/Eviction Notice
Upload Rent Ledger form Landlord
Upload Employment pay stubs from before COVID (Feb-Mar-April-May). Shows job changes before and after COVID, showing decrease change of income. For all household members.
Upload Award Letters from all income sources (Feb-Mar-April-May) (SSI, SSDI, Child Support etc.). For all household members.
Upload Letter of termination, Reduction in hours or Furlough from employment., Due to COVID-19. For all household members.
Upload Drivers License or Photo ID for all adults in the household (age 18 or older.)
Direct your questions to COA-Rentassist@auroragov.org
