APARTMENT ASSOCIATION OUTREACH, Inc.
RENTAL ASSISTANCE
REFERRAL FORM
07/2010
Referrals to Welcome House of Northern Kentucky
must be faxed, mailed or emailed.
FAX this completed form to: 859-431-6297 ATTN: Assessments ~OR~
MAIL to: Welcome
House, 205 W. Pike Street,
Covington,KY41011, ATTN: Assessments
~OR~ Email to: assessments@welcomehouseky.org
Referring Landlord/Property Owner
Name:______________________________________________________________
Contact Info(Office or cell phone): __________________________________________
Date of Referral:______________________________________________________
Referral Information
Name of Individual/Family:_______________________________________________
Address:_____________________________________________________________
Phone number where referral can be reached:__________________________________
Length at residence:____________________________________________________
Amount of monthly rent:_________________________________________________
Total amount owed:____________________________________________________
Brief description of
emergency:__________________________________________________________
___________________________________________________________________
Each referral will be contacted within 24 hours or next business day for a phone assessment or face to face appointment. This is to determine eligibility for funds (whether family meets GCNKAA rental assistance guidelines). Further documentation from both Landlord and family referred will be required in order to secure funds. Questions? Call Assessments at 859-431-8717 or email at: assessments@welcomehouseky.org
Or click to download the pdf
Kentucky Rental Assistance Referral Form
