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  • NR COVID-19 Tenant-based Rental Assistance

    Preliminary Application


    If you are a New Rochelle resident in a rental property and your income has been substantially reduced, due to the COVID19 Pandemic and/or the corresponding government-imposed shutdown, you may be eligible for temporary rental assistance from the City of New Rochelle’s Tenant-Based Rental Assistance (TBRA) Program for COVID-19. Download Fact Sheet to learn more.

    Download Application

    Part 1: Head of Household

    Click or drag a file to this area to upload.
    Evidence of legal address claimed at the time of application must accompany this form when returned. Acceptable evidence includes a copy of a driver's license or other official document listing head of household, spouse, or co-head at claimed legal address. Preliminary Applications returned without evidence of legal address cannot be accepted.
    Home Number
    Cell Phone Number
    Work Number

    Please respond to the items below (optional)

    *Questions regarding Ethnicity and Race are optional. Please select "Prefer Not to Answer" if choosing not to answer.
    Select ALL that apply. Optional.

    Part 2: Household Information

    List information for adults first, then children under age 18. Use "F" or "M" to indicate sex. List relationship of each person to the Head of Household. Attach additional sheet if family has more than ten members.

    Part 3: Family Income and Assets

    List total gross income (before taxes) and payments received by each family member age 18 and older for wages, military pay, pensions, social security, SSI, welfare, child support, unemployment, business, profession or any other source. Include payments made to family members 18 or older on behalf of other family members under age 18.

    Household Assets

    List total cash value and total income received for assets owned by all family members

    Part 4: Eligibility and Preferences

    Your response to the following statements will help determine your eligibility for rental assistance. Please answer all questions.

    Part 5: U.S. Citizenship Notification and Certification

    Program eligibility is contingent upon the submission and verification of evidence of citizenship or eligible immigration status prior to the time assistance is made available. Based on the evidence submitted at that time, assistance may be prorated, denied or terminated following appeals and informal hearing processes.

    I certify that the information on this form is true and complete to the best of my knowledge and belief. I understand that I can be fined up to $10,000, or imprisoned up to five years if I furnish false or incomplete information.