Rental & Mortgage Assistance Program Application

Maui Economic Opportunity, Inc. (MEO) administers a variety housing assistance services through various funding sources in partnership with a number of community agencies. These programs provide eligible households with necessary assistance to prevent evictions and homelessness throughout the County of Maui and may include households whose income was affected by COVID-19. As a requirement to administering these services, applicants must accurately complete this application. Any false or omitted information found may result in denied services. Target Population: ✓Homeless ✓At-risk of Homelessness ✓Moving from emergency or transitional housing ✓Pandemic impact Minimum Requirements: Identification Social Security card Current income/asset verification valid lease/rental agreement and/or mortgage statement * Please note additional documents may be requested once application is reviewed.

Please allow yourself at least 1 hour to fill out this application and gather requirements. Information will not be saved until the application is submitted.

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Requested Assistance*
Assistance Requested*
How long have you lived on Maui?*

In the last 365 days

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If so, from what Agency?

If you have received assistance from several agencies during the year, please list the most recent.

If you are unsure of the specific date, please list as the first of the month

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Applicant Information

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Household Information

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Enter total number

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Please provide the names and birthdays over everyone in your household Example: Jane Doe, October 5, 1991 John Doe, March 16, 2001

Do you have a current lease agreement?*

Please provide your landlord or property manager's name and contact information.

https://www.meoinc.org/wp-content/uploads/2021/08/Consent-Form-to-Release-Information.pdf By checking this box below, I confirm I have read and accept the terms of the consent to release information.

https://www.meoinc.org/wp-content/uploads/2021/08/Voluntary-Affirmative-Action-Data-for-Participants.pdf By checking this box below, I allow my information provided to be used for this form.

https://www.meoinc.org/wp-content/uploads/2021/08/Grievance-Process.pdf By checking this box below, I verify that I have read and agree with program agreement, rights & grievance process.

https://www.meoinc.org/wp-content/uploads/2021/08/EEO-is-the-Law-Participant-Acknowledgement.pdf By checking this box below, I verify that I have read and acknowledge the information provided through this form.

https://www.meoinc.org/wp-content/uploads/2021/08/Notice-of-Privacy-Practices-Acknowledgment.pdf By checking this box below, I verify that I have read and agree with the Notice of Privacy Practice that was provided.

I (applicant), by checking the box below, understand that this application will be reviewed and additional information may be needed to determine program eligibility. I understand what documents are required of me to apply for the rental program and I must be forthright and truthful with all information provided to include but not limited to, disclosing assistance received by any one of the following agencies within the past year; Ka Hale A Ke Ola, Women Helping Women and Family Life Center, Catholic Charities Hawaii.

File Upload: You may upload any required documents here (see list above). Photos (jpg, jpeg, png) of documents or PDF scans are accepted. Please ensure any photos are clear and large enough to print clearly. Please take note that if any document can not be opened, read, or downloaded, you will be required to provide it again.

Drag and drop files here or

OFFER AND ACCEPTANCE OR WAIVER OF FREE INTERPRETER SERVICES

English is my primary language*
Do you need an interpreter?

If you do not see your language listed please type below

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By clicking checking the box below, I agree to terms & conditions. I understand that MEO may secure an independent interpreter to observe my interpreter to ensure the accuracy of the communications. I understand that the use of family or friends as interpreters may not be the most effective way to help me access the benefits and services that MEO provides. I understand that MEO does not recommend the use of family members or friends as interpreters and prohibits the use of minors as interpreters. I understand that if I do not want interpreter services at this time, I have the right to change my mind in the future and have MEO provide free interpreter services at that time or bring an interpreter of my choice.

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