ATHENS LAND TRUST AFFORDABLE HOUSING PROGRAM



Athens Land Trust Affordable Housing ProgramCOVID-19 Assistance ApplicationBackground: Athens Land Trust’s COVID-19 Assistance Program is designed to provide relief for those experiencing a loss of income due to the COVID-19 pandemic. If you have any questions, please call our COVID-19 Assistance line at 706-431-3157.Application Procedures and RequirementsThe attached application will be used to determine if you are eligible for the Athens Land Trust Affordable Housing Program COVID-19 Assistance Program. Persons interested in participating in this program must meet the following program requirements:Household income must be at or below 50% of the HOME Adjusted income limits for Athens, GA1 person2 persons3 persons4 persons5 persons6 persons7 persons8 persons23,00026,25029,55032,80035,45038,05040,70043,300Complete ALL pages of the application Provide a copy of your IDProvide a copy of pay stub or unemployment benefit statementCurrent copy of bills or statements that you need assistance with paying, indicating the amount owed and account informationSign and date the applicationI/We certify that I/We have read and understand the above program requirements and have completed the checklist of application procedures.applicant signaturedateco-applicant/spouse signaturedateApplicant InformationHomeowner/Resident Name(s)--All Household Members:Address: Phone Number: Email Address:Race or National Origin: (Check one box below)American Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderMulti-Race (please specify)________________________________AsianWhiteI do not wish to furnish this informationBlack or African AmericanOther Single RaceEthnicity: (Check box→)HispanicNot HispanicIf you own your home, who is your lender? If you rent, who is your landlord? Provide their contact information and how you pay your rent/mortgage (mail a check, have it automatically deducted from checking account, etc...)________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ What is your monthly mortgage or rent payment? If you are not current with your payments, how far behind are they?________________________________________________________________ ________________________________________________________________ Has your income been interrupted by the COVID-19 pandemic? If so, when did your income change? ________________________________________________________________________________________________________________________________Date released from work due to COVID 19 __________________________________ Date of work reduction or furlough due to COVID 19 _________________________ What is your current income? _____________________________________________ Have you applied for unemployment benefits? __________________________ If so, what amount are you receiving and when did you begin receiving benefits?_________________________________________________________ Have you received any assistance from other agencies? If so, which agencies? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Which bill(s) do you need assistance in paying? What is the amount currently owed?________________________________________________________________ ________________________________________________________________ Please provide a current copy of your statement(s) that you need assistance paying, indicating the amount owed and account information.By signing below, I am: ● Authorizing ALT to officially begin the process of assisting me, if possible, with some payment to entities on my behalf. I/We authorize ALT to communicate with my/our lender, landlord, or utility provider, and obtain information about my/our accounts.● Agreeing that ALT is not financially or contractually obligated to pay my bills on my behalf. ● Agreeing that the information I’ve provided to ALT is factual and current.● Certify that my debts are related to the COVID pandemic.____________________________________ __________________ Signature Date ____________________________________ ___________________ Signature Date ................
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