Please use this form to submit your Hardship Statement to support your Assistance Request.

You must also submit the MHHD Client Intake - you can access it here: MHHD ONLINE INTAKE

If you are requesting rental or hardship assistance, please see below:

Must have a hardship within last 30 days or have Coast Electric.
Must complete Intake and also the the Hardship section below.
Documentation of hardship and other supporting documents will be required.
Must not have an outstanding balance with the landlord; back rent will not be paid.
Must not have a court date set for writ of possession within the next seven days.
Repeat clients must wait a year from date of assistance to reapply.
Must turn in all supporting documents that apply within 30 days.
Those affected by the COVID-19 Virus and are in need of assistance MUST provide proof that they have applied for unemployment before requesting assistance.
IRS Relief Check Verification of use will be required. Relief Checks must be used to pay any debts/rents first.

ALL ASSISTANCE PROGRAMS
CLOSED UNTIL AFTER THE FIRST OF THE YEAR

Indicates required field

Date

Name

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Type of Assistance Requesting

Rental

Living (food, essentials)

Utilities

Other…

Amount Requested

Please describe your hardship

What upcoming resources will you have to pay your bills?

In the past 30 days, where else have you applied for assistance?

Where?

Employment Phone Number/Contact Info - for Verification (If requesting assistance Required)

Rental Assistance - Enter contact info for Landlord/Rental Office

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MHHD Hardship