ELIGIBILITY Form

(Emergency Rental Assistance Program)
To be submitted by Tenant to
ERAP-WINDRIVER
along with an Application for funding.

The Tenant listed below is filling out, attesting to, and signing this Eligibility Information
Statement. The Tenant has applied to ERAP-WINDRIVER for U.S. Department of
Treasury’s Emergency Rental Assistance under the Consolidated Appropriations Act,
2021. To determine the Tenant’s eligibility for this COVID-19 pandemic program, the
Tenant must submit this Statement, as well as an Application, to ERAP-WINDRIVER.
The Tenant’s Landlord and Utility Provider(s) are not part of this Eligibility Information
Statement

TO QUALIFY FOR ASSISTANCE UNDER THIS PROGRAM, YOUR HOUSEHOLD
MUST HAVE AN INCOME THAT IS LESS THAN EIGHTY PERCENT (80%) OF THE
AREA MEDIAN INCOME.