Scholarship Application

Phone

This field is for validation purposes and should be left unchanged.

About You

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City ZIP Code

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Date Of Birth(Required)

Eligibility & Household Income

To qualify for most Northern Colorado programs, households must generally be at or below 60% to 80% of the Area Median Income (AMI). Current Monthly Household Income: Total gross income from all sources.

Current Monthly Household Income:(Required)

Income: Total gross income from all sources.

Income Sources: (Check all that apply)(Required)

Employment/Wages

Social Security (SSI/SSDI)

Unemployment Benefits

Child Support/Alimony

Public Assistance (TANF/SNAP)

Hardship Statement:(Required)

Briefly describe the life event that has affected your ability to pay rent (e.g., treatment, job loss, reduction in hours).

Housing & Rental Details

Monthly Rent Amount(Required)

Total Past Due Amount:(Required)

(If applicable)

Landlord/Property Manager Name:(Required)

Landlord Phone(Required)

Landlord Email(Required)

Are you currently facing eviction?(Required)

Yes

Steps Toward Stability(Required)

I am committed to long-term housing stability. To address my current crisis, I have [mention proactive steps, e.g., applied for new employment, started a budget with a counselor, or applied for other assistance].

Certification & Authorization

I certify that the information provided is true and accurate. I authorize this nonprofit to contact my landlord to verify rental details and coordinate payment.

Scholarship Application