CMTX - Initial Assessment

Initial Assessment for Program Entry

CMTX
(Only complete the assessment if you are seeking assistance for the CURRENT month as we do not have ANY funding for arrears) Anything after the 15th of the month is considered back rent.

CMTX
Client Name*

First NameLast Name
Date of application *

MonthDayYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Name of Apartment
Address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Assess the Following

All of the questions below will be taken into consideration on next steps
Do you receive Sec 8 Housing?

YESNO
Does your landlord/Apartment Complex accept 3rd party direct deposits? (If NO, please do not complete as we will not be able to assist you) No Exceptions!

YesNo
How long have you lived in your apartment, is it greater than 90 days?*

YesNo
Are you Collin County Resident*

YesNo
Do you have an eviction*

YesNo
Do you have a portion of your rent? This program is partial rent assistance under $900*

YesNo
Have you used this program in the last three years?*

YesNo
Do you owe rent for last month?*

YesNo
Is the lease in your name?*

YesNo
How many are in your household?*
What is the amount of your rent?*
What can you pay towards your rent?*
How many bedrooms?*
Are you currently employed?*

YesNo
What is your gross employement/UE benefits (income before taxes)?*
Is that,*

WeeklyBi-WeeklyMonthly
What are your other income sources

SNAPSSI/DisabilityChild Support
Are you receiving assistance from any other agency including any Housing Authorities (Sec8)*

YesNo
If yes, Who?
Reason you could not pay rent this month
Result
If you qualify, you will be able to submit and the application will populate in seconds,

if there is no Submit button you did not qualify!!!
Should be Empty:

Initial Assessment for Program Entry

(Only complete the assessment if you are seeking assistance for the CURRENT month as we do not have ANY funding for arrears) Anything after the 15th of the month is considered back rent.

Assess the Following