COVID-19 Emergency Rental Assistance

Any misstatements or omissions in this application may result in disqualification of housing assistance. Further, if assistance is provided, you may be required to repay all program monies expended on your behalf if such misrepresentations are discovered at a later date. All questions must be answered

Median Income

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Lessee/Client

Tribal ID

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Phone

(###)

###

####

Tribal ID #

Lessor/Landlord

Lessor/Landlord Name

First Name

Last Name

Lessor/Landlord Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Rental Amount

The Mashpee Wampanoag Tribe Housing Department agrees to pay COVID-19 Emergency Rental Assistance not to exceed $500.00 to the "Lessor" on behalf of the above "Lessee" No oral agreements have been entered into and all modifications or notices shall be in writing to be valid.

Monthly Rental Amount

Acknowledgement of Terms

I acknowledge that I have read and understand this agreement and hereby acknowledge that all of the information provided is accurate and that payment is subject to approval.

Check box to acknowledge

Today's Date

YYYY

For Office Use Only

Housing Department Employee Signature_________________________________________ Date_____________________________________________ Michelle Tobey, Housing Director Signature_________________________________________ Date_____________________________________________

COVID-19 Emergency Assistance Required Documents

Housing Application In-Take Form signed by Applicant and Spouse/ Domestic Partner
Tribal Verification (copy of Tribal ID card or verification from other Tribal Organization)
Copies of Social Security Cards for every member of the household
COVID-19 Emergency Rental Assistance (RA) Agreement and completed W-9 (if applicable)
Lease or proof of residency (Verification for Emergency RA Agreement)
COVID-19 Emergency Mortgage Assistance (MA) Agreement and completed W-9 (if applicable)
Current Mortgage statement/bill (Verification for Emergency MA Agreement)