Internal Rent Form

ECHO Internal Rent Assistance Request

This program provides emergency financial assistance to Gadsden, Leon, and Wakulla county residents facing the loss of their housing due to a financial or other crisis. The intent of the program is to provide case management and financial assistance for late or upcoming rent payments to enable families and individuals to avoid eviction and remain stably housed after receiving the assistance.

"*" indicates required fields

Have you previously received rent assistance from ECHO?*

Yes

Due to limited funding, eligibility is limited to first-time recipients of financial assistance from ECHO.

Applicant Name (First Last)*

Number of members in household*

Email Address*

Phone*

Residential street address where lease is active*

Street Number and Name

Number of bedrooms*

City*

County*

Total amount owed (past due balance, late fees, and court costs)*

Brief description of your hardship resulting in past due rent*

Clicking the Submit button below does not guarantee approval for rent assistance or serve as a promise to pay your landlord. Funding is limited and requests will be processed in the order they are received. Please allow up to 5 business days for a response to your request.