Rent Assistance Apply PATH | East Texas

Head of Household Information(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Do you have a job/income?

Yes or No

Does your current income cover your expenses?

Yes or No

Combined Monthly Income for ALL Household Members(Required)

Please tell us your Monthly Income.

How many months are you behind?(Required)

Tell us how many months you are behind and list those months. (ie. 3 Months and September, October and November)

Monthly Rent(Required)

Please tell us your Monthly Rent Amount.

What date is your rent due?(Required)

Please type in the date of when your rent is due.

How many people in your household are under the age of 18?(Required)

Is there a Veteran in your household?(Required)

Yes

No

Please tell us what caused you to be behind on rent?(Required)

Do you have an eviction notice?(Required)

Please Choose Yes or No - Landlord Letter, 3 Day Notice or Late Notice.

Is your landlord taking you to court? If so please enter your docket number.

(example - XX-XXXXXX)

Have you been helped with rent by PATH previously?(Required)

Please Choose Yes or No

Are you normally able to pay your rent with your income?(Required)

Please Choose Yes or No

Your Phone(Required)

Rent Assistance