Apartment Association Outreach, Inc.
Rental Assistance Referral Form
Referrals to Freestore/Foodbank must be faxed or mailed.
FAX this completed form to: 513-357-4821 Attn: Angela Belser
Mail to: Attn: Housing Dept, Freestore/Foodbank, 112 East Liberty St, Cincinnati, OH 45202
Referring Landlord/Property Owner
Name:______________________________________________________________________
Contact Info: (office or cell) _____________________________________________________
Date of referral: ______________________________________________________________
Landlord’s reference: __________________________________________________________
___________________________________________________________________________
Referral Information
Name of Individual/Family: _____________________________________________________
Address: ____________________________________________________________________
Phone number where referral can be reached: _______________________________________
Length at residence: ___________________________________________________________
Amount of monthly rent: _______________________________________________________
Total amount owed: ___________________________________________________________
Nature of emergency: __________________________________________________________
___________________________________________________________________________
Further documentation from both Landlord and family referred may be required in order to secure funds. Questions? Call Angela Belser, 513-357-4811
Or click to download the pdf
Ohio Rental Assistance Referral Form
