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Short-Term Assistance Program for Rent, Mortgage & Utilities

  1. Dubuque, IA

    You must live within the city limits to be eligible.

  2. If you don't have an email, please denote N/A

  3. Number of people in household:

  4. Do you rent or have a mortgage?*

  5. If you don't pay utilities, please note "N/A"

  6. Were you working as of January 1, 2020? *

  7. Did you lose employment because of COVID-19 or was your income reduced by 25% because of COVID-19?*

  8. Did you apply for unemployment?*

  9. Have you lived in your rental/home for the last 60 days?*

  10. Before COVID19, as of March 1, 2020, were you current on rent/mortgage? *

  11. Before COVID19, as of March 1, 2020, were you in good standing with utilities? (examples: payment plan, annual plans, no shut off notice. Please contact our office if you are unsure of your situation)*

  12. Is this the only housing assistance program you are applying for or would be receiving? *

  13. Is your household’s current income under the following limits? 1 person at $29,050, 2 people at $33,200, 3 people at $37,350, 4 people at $41,450, 5 people at $44,800, 6 people at $48,100, or 7 people at $51,400?*

  14. Leave This Blank:

  15. This field is not part of the form submission.