MCCAC security deposit application

MCCAC security deposit application

First name (head of household)*

Last name*

Organization that referred you (if applicable)

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Date of this application*

Age*

Primary racial affiliation

Primary language

Veteran?*

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Fleeing or attempting to flee domestic violence?*

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Does household have children under age 18?*

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Phone number

Email address

Current county where you are living*

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How/where can we contact you?*

Number of household members*

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Address where you are approved to rent a unit*

Name of landlord for unit where deposit is needed*

Phone of landlord where deposit is needed*

Email of landlord where deposit is needed*

Date when you need deposit*

Requested deposit amount*

Do you have a HUD voucher?*

Will the household be homeless without assistance?*

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Gross monthly income (all sources, before taxes)*

File Upload*

Please upload and include the following documents (scan or take a photo with your phone) with your application.

Proof of ID (examples of acceptable documentation include: driver's license, social security card, letter from a government agency with your name on it, etc.)
Proof of ALL sources of income for last 60 days (examples of acceptable documentation include: social security or other benefit statement, paystubs, etc.)
Proof of application/approval at the address where you are requesting security deposit assistance
Proof of security deposit amount needed

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