City of Frisco 
COVID-19 Emergency Rental & Utility Assistance
Screening Form


If you reside in the City of Frisco and your household is impacted, please complete the following form.
Only one submission is needed. Multiple submissions will not help us to process your application faster.


Si reside en la ciudad de Frisco y su hogar se ve afectado, complete el siguiente formulario. 
Solo se necesita una presentación. Varias presentaciones no nos ayudarán a procesar su solicitud más rápido.

Are you a resident of the City of Frisco? / ¿Es residente de la ciudad de Frisco?*

You must have first applied for and received Rental Assistance for the City of Frisco as of March 2021, OR been informed that you previously could not be qualified.  Please complete the Application for Frisco Emergency Rental Assistance on the previous page.

Primero debe haber solicitado y recibido asistencia de alquiler para la ciudad de Frisco a partir de marzo de 2021, o se le debe haber informado que anteriormente no podía calificar. Complete la Solicitud de asistencia de emergencia para el alquiler de Frisco en la página anterior.

This form is limited to City of Frisco residents. Please refer to your local jurisdiction for assistance. 

Este formulario está limitado a los residentes de la Ciudad de Frisco. Consulte su jurisdicción local para obtener ayuda. 


Name (Head of Household) / Nombre de la Cabeza de la Familia*
Do you reside at the same address? / ¿Vives en la misma dirección?*
Ex. 1132
Ex. Main Street



Has your employment changed since your original application? / ¿Ha cambiado su empleo desde su solicitud original?*
Are you receiving Unemployment Benefits? / ¿Recibe beneficios por desempleo?*
No File Chosen
File uploads may not work on some mobile devices.
Please use Maximum Resolution
Are you requesting rental assistance? / ¿Está solicitando asistencia para el alquiler?*
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Please use Maximum Resolution
Which of the following utilities are you requesting assistance for? / ¿Para cuál de las siguientes empresas de servicios públicos solicita asistencia?
Check all that apply / Marque todo lo que corresponda
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File uploads may not work on some mobile devices.
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File uploads may not work on some mobile devices.
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Use your mouse or finger to draw your signature above

Additional Documents /  Documentos adicionales

Please upload any additional documentation here. If you are unable to upload all relevant documents, please email them to the person who originally processed your application. 

Sube cualquier documentación adicional aquí. Si no puede cargar todos los documentos relevantes, envíelos por correo electrónico a la persona que procesó originalmente su solicitud.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
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File uploads may not work on some mobile devices.

Reviewer Information

Started Processing Application
:  
If applicant earns more than the current AMI based on all cources of income, can they provide a Tax Return for 2020 which shows an Adjusted Gross Income?
Name, phone number, email, etc.
Has landlord been contacted?
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.

Payment Information

Client Name
ex. March, April, May

Payment Amounts

$
$
$
$
$

Rent Mailing Information

Pay to
Address

Electric Mailing Information

Pay to
Address

Gas Mailing Information

Pay to
Address

Water Mailing Information

Pay to
Address

Other Mailing Information

Pay to
Address

Program Manager Approval

Approved by Program Manager for payment*

FOR ACCOUNTING USE ONLY -- Rent Payments

Check Date
Date Cleared Bank

FOR ACCOUNTING USE ONLY -- Electric Payments

Check Date
Date Cleared Bank

FOR ACCOUNTING USE ONLY -- Gas Payments

Check Date
Date Cleared Bank

FOR ACCOUNTING USE ONLY -- Water Payments

Check Date
Date Cleared Bank

FOR ACCOUNTING USE ONLY -- Other Payments

Check Date
Date Cleared Bank
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