CAP Application

Application Info
Household Info
Household Income
Confirm

Application Information

Please complete the following information in order to submit your application for a security deposit waiver or enrollment into the CAP program. Once your application has been submitted, one of our CAP Case Managers will be in contact with you within 3 business days.

Account Number *

Application Type * Security Deposit Waiver Enrollment

Agency Selection *

Preferred Contact * Phone Email

Service Address *

City *

State *

Zip Code *

Household Information

Enter information for the primary account holder on the application below and then select “Save” in order to add additional members of the household or to proceed to the next step in the application.

Household Members:

Full Name	Email	Phone Number	Date of Birth	Edit/Remove
				Edit Remove

Primary person information

First Name *

Last Name *

Primary ID Type * <strong>The preferred primary ID is social security number.</strong>

Email *

Primary Phone Number *

Date of Birth *

Relationship Type *

Total Monthly Income *

Primary Source of Income * <strong>If income is from multiple sources, please select the source which accounts for the most amount of income.</strong>

Application Information

Account Number:

Application Type:

Preferred Contact:

Agency Selection:

Address:

City:

State:

Zip Code:

Household Information

Name:

Email:

Primary ID Type:

Primary ID:

Phone Number:

Date of Birth:

Relationship Type:

Monthly Income:

Primary Source of Income:

Household Income

Household Income:

Thank you! Your CAP application is being processed.

Confirmation:

A confirmation email has been sent to the primary point of contact on your application. We will be in touch once additional information or action is needed.

About your CAP application

Application Information

Account Number:

Application Type:

Preferred Contact:

Agency Selection:

Address:

City:

State:

Zip Code:

Household Information

Name:

Email:

Primary ID Type:

Primary ID:

Phone Number:

Date of Birth:

Relationship Type:

Monthly Income:

Primary Source of Income:

Household Income

Household Income: