Online Rent & Utility Assistance Request Form
Our weekly rent & utility assistance screening form for families with children under the age of 18 or seniors age 55 or older living in Oklahoma City or Oklahoma County is open on Monday mornings at 7:00 a.m. via our website until the number of requests received exceeds our funding capacity for the week. We do not accept requests during weeks with a holiday.
Required Documentation
Please note, some programs may require additional documentation. After completing our initial screening, your case manager will confirm the required documents.
- Completed agency application.
- Signed authorizations for release of information for property owner/manager.
- Signed authorizations for release of information for utility provider(s).
- Copy of driver’s license or state identification card and Social Security cards for adult family members.
- Copy of Social Security cards or other verification of Social Security numbers for children (DHS printout, tax return, etc.).
- Documentation of Income or Pending Income Verification
- Copy of lease if requesting rent assistance.
- Copy of eviction notice or 5-day notice to quit.
- Copy of utility bill(s) with cutoff notice if requesting assistance with utility bill(s).
- Proof of hardship that has caused the difficulty in paying the bill.
- Completed property owner/manager verification form.
- Completed W-9 from the property owner/manager.