ERAP Application

Primary Application
  • Applicant & Household Information
  • Financial Hardship
  • Housing Status
  • Household Income
  • Certification of Eligibility
  • Release of Information
  • Documentation
0% Complete
1 of 7
Who is filling out this application? *

Section 1: Primary Applicant Information

Household Address *
Household Address
Address Line 1
Address Line 2
Please confirm your email address by entering it again.
Hispanic or Latino?
Would you like to authorize an alternate contact to discuss your application?

Alternate Contact Information

If you would also like us to communicate directly with another person or agency on your behalf regarding your application, or if you are filling out this application for someone else, please provide the following alternate contact information:
Please confirm the email address by entering it again.

Persons Residing In The Household

The first entry is for the Head of Household (HoH).
Since this household member is over the age of 18, they will need to sign a ‘Release of Information’ form. To invite them to sign this form online (fastest), enter their email address here. You may also download and print a paper copy of the form here.
Please confirm the email address by entering it again.