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HomeSafe Application

First Name *

Last Name *

Suffix

Email Address *

Phone Number *

Phone Type *

Home

Work

Mobile

Voicemail Only

Street Address *

Apt #

City *

State *

Postal Code *

Birthdate * +

Social Security Number

Preferred Language/Languaje Preferido *

Ethnicity 🛈

Race 🛈

Marital Status

Gender

Education 🛈

Employment Status *

Please upload proof of employment status. * 🛈

RI resident for the last 365 days? * 🛈

Yes

No

Are you involved in a DV situation? *

Please be ready to provide proof of a DV situation, such as a waiver or police report.

Please upload your RI license that proves RI residence for 365 days, or other proof of residency * 🛈

Household Size *

Please upload the first page of your most recent tax return which lists the names of each household member *

Household Names and Birthdates * 🛈

Please upload the past 2 months of bank statements for each adult living in the household

*

Active member of the U.S. Military?

Documentation of military income benefits *

Veteran of the U.S. Military?

Documentation of military income benefits *

Household members in Military or Veteran?

🛈

Documentation of military income benefits *

Are you legally disabled?

🛈

Please upload SSI/SSDI award letter *

Is anyone else in the household disabled?

🛈

Please upload SSI/SSDI award letters for each disabled household member

*

I own rental property

🛈

Please upload rent receipts or bank statement showing rental deposits. *

I receive child support

🛈

Please upload statement screen from child support database showing payee and amounts. *

I have a Section 8 Voucher

Please upload copy of Section 8 voucher or letter from issuing agency. *

Current short-term emergency * 🛈

Please upload TDI letter *

Please upload letter from shelter proving homelessness *

Please upload copy of DV Waiver *

Please upload letter from DOH or building inspector documenting lead paint *

Please upload letter from the Red Cross documenting fire/disaster. *

Please upload letter from building inspector documenting code violation. *

Please upload mortgage statement & lawyers letter or 30 day termination letter. *

I need financial assistance with: *

Past due rent

Past due mortgage

Late Fees on rent or mortgage

Moving expenses

Past due utilities

Please upload 5 day demand letter or landlord letter & lease *

Please upload mortgage statement. *

Please upload lease and 5 day demand letter or mortgage statement. *

Please upload moving bill/quote from moving company. *

Please upload complete utility bill for each past due service. *

Briefly describe your situation. * 🛈

Total amount of assistance needed * 🛈

How do you plan to make future payments? * 🛈

Have you applied for Housing Assistance elsewhere? * 🛈

Where did you apply? *

For which months did you apply? *

What type of assistance did you apply for? *

mortgage

rent

utilities

other

Were you funded? *

Yes

No

I certify truthful information * 🛈

Agree

I agree to application review * 🛈

Agree

I authorize contact with my creditor * 🛈

Agree

I understand any payment is to creditor * 🛈

Agree