San Juan Emergency Rental Assistance Program

Application below – please note this is for San Juan County residents only. Please contact your local Community Action Agency for rent assistance in the county in which you reside.

If you are unable to complete the below application and would like to speak with someone about your rental assistance needs, please leave a message at (360) 734-5121 extension 308. Messages will be responded to in the order in which they are received. Language interpretation services are available.

San Juan Emergency Rental Assistance Program

  • IMPORTANT: Be sure to click the submit button at the bottom of this page after you complete this form.
    PLEASE NOTE: Allow 2-3 weeks for processing your request. Your request will be processed in the order received.
  • Household Information

  • First NameLast Name 
  • First NameLast Name 
    While this is not required for program eligibility, there are programs and services specifically for Veterans in San Juan County and this information may help provide appropriate referrals as needed.
  • WA State is collecting demographic data on head of households assisted with this program. None of this information will be used to screen for eligibility, but instead to evaluate how equitably the funds are administered. Households do not have to answer these questions, they are optional.
  • By providing this number you are giving permission to leave a detailed message about your request. If no phone number, please use (000) 000-0000.
  • Secondary phone number (optional)
  • By providing an email address you are giving permission to receive a detailed email response about your request.
  • Household Eligibility

    Household must meet BOTH Household Eligibility Criteria below. Your application will be reviewed and may be denied based on the information listed.
  • A household is one of more individuals seeking to maintain housing together.
  • First NameLast NameSource of IncomeAmount received in past 60 days 
    Please include ALL adult household members (18 and over )and any minors receiving unearned income (ie child-only TANF). Please list ALL income sources separately by household member received in the past 60 days. Income limits apply.
  • Additional Criteria

    Any household member must meet at least ONE Additional Criteria listed below. Your application will be reviewed and may be denied based on the information listed.
  • Please click all Additional Criteria met by any member of the household
  • Please click all Additional Criteria met by any young adult member of the household age 24 or younger
  • Rental Information

    Please complete all rental information requested. Payments to landlords or friend/family can only be up to 80% of total rent due (arrears, current, future) OR the Fair Market Rent rate. Rental assistance is not guaranteed as requested.
  • Monthly RentBedroom Size (ex: studio, 1 bedroom, 2 bedroom, 3 bedroom, etc.) 
    Please list the amount of rent you are responsible for and the bedroom size of the unit. If you rent from friends/family, please list the number of bedrooms in the house in one line and number of "sleeping spaces" you are responsible for in the next.
  • Month (ex: June, July, August, etc.)Amount Owed 
    Please list the months of rent you are requesting assistance for and the amount due - must include one month of arrears and can include current and/or future rent. Rental assistance is not guaranteed as requested.
  • Landlord Information

    Please list information about who you pay rent to. This can be a landlord with a formal lease or include friends/family with an informal agreement. By providing your landlord or friend/family member's name and contact information, you are giving permission to contact them about your request.
  • By providing your landlord's or friend/family member's number and/or email you are giving permission to contact them about your request.
  • Secondary phone number (optional)
  • By providing your landlord's or friend/family member's number and/or email you are giving permission to contact them about your request.