Qualification

Are you a Fort Bend County Employee or Contractor? (*) Note: Fort Bend County Employees or Contractors are not eligible for this program.

Are you related (i.e. spouse, child, parent or close relative) to a Fort Bend County Employee or Contractor (*)

Qualification

Are you a resident of Fort Bend County, Texas? (required)*

Have you received rental or utility assistance from any other government programs or Fort Bend County, or a Fort Bend County City (i.e. Sugarland, Richmond, Rosenberg, etc) in the past 3 months? (this does not include the stimulus check received) (required)*

Is your inability to pay rent due to financial hardship resulting from the economic impact of COVID-19 as indicated by job or employment loss or reduction of employment? (required)*

Are you in arrears for your current lease (i.e. owe back rent)? (required)*

Are you needing assistance with payment of utilities (i.e. water, gas electric)? (required)*

Personal Information

To qualify, the Applicant must be the Lessee/Borrower and must truthfully answer all questions.

Title

Applicant Name (required)*

Applicant Email (required)*

Spouse’s Name

Address, City, County, State, Zip Code (required)*

Driver’s License Information (Please upload all documents before submitting your application.)

Driver’s License Date Issue

Driver’s License Expiration Date

Date of Birth (required)*

Gender (required)*

Race

Phone Number – Primary (required)*, Cell, Secondary

Applicant’s Current Monthly Income (required)*

Total Household Income as of December 31, 2020. (Please upload all documents before submitting your application.)

What is your current employment status, Select one of the following:

Number of household occupants including yourself

Name of other members in the household and the date of birth of each

Landlord / Lease Information

For the following enter the contact information your Landlord, (if you are a tenant renting or leasing). Note: You must enter your Landlord’s contact information.

Monthly Lease Amount (required)* (Please upload all documents before submitting your application.)

Landlord Address (required)*

Utilities

Are you requesting Utility payment assistance?

Is your current and most recent utility (ies) bill past due?

If Yes, then check (or select) which type (can select multiple):

Most Recent Utility Bill(s) (if applicable). (Please upload all documents before submitting your application.)

Water

Electricity (Please upload all documents before submitting your application.)

Gas (Please upload all documents before submitting your application.)

Required Documentations (PLEASE Upload before submitting this application or Drop-Off at Fort Bend County Office at 1601 Industrial Blvd, Sugarland, TX 77478) before submitting this application.

• Copy of a valid state or government issued photo ID.
• Current Rent/Lease Agreement.
• Provide income prior to March 1, 2020 (provide three (3) check stubs with consecutive date all prior to March 1, 2020)
• Most recent Utility bill(s) (if applicable)
  • Water
  • Electric
  • Gas
• Disconnect/Late notice (if applicable)
  • Water
  • Electric
  • Gas
• Proof of income for the prior two (2) months (2019 TWC Unemployment statements, payroll checks, interest statements).
• Proof of income loss due to COVID-19 (submit one of the follow):
  • Copy of Form 1040 for 2019 and 2020 as filed with the IRS for the household;
  • Current Texas Workforce Commission award letter and payment history;
  • All pay or wage stubs for the prior two (2) months;
  • Letter from employer, on employer letterhead stating layoff or income loss;
  • Any other Verified loss of stipend showing income loss
• Child support letter showing reduction

By checking the following agreement and submitting this online form, I/we certify that the information provided is true and complete to the best of my/our knowledge. I/we further certify that all information furnished in support of this application is true and complete to the best of my knowledge. False statements will result in your application being rejected. I/we understand that the information submitted will be verified prior to approval.

I agree to notify Fort Bend County within five (5) business days of any discrepancies on the wages I am reporting for this program. Further, I understand and acknowledge The County’s right and responsibility to recapture all or a portion of the CARES ACT award I may be awarded should the information I provided is false and fraudulent under penalty of law.

ENTER FULL NAME (required)*

DATE (required)*