KEPA Pre-Application Checklist
 Basic Information
 
☐ All of the Tenant's contact information
 ☐ All of the landlord's contact information 
   
 ☐ A list of who lives in your home, including: 
   
          ☐ First & last name 
   
     ☐ Age 
   
          ☐ Date of birth 
   
          ☐ Gender identity 
   
          ☐ Race 
   
          ☐ Whether or not they are Hispanic 
   
          ☐ Their relationship to you 
   
          ☐ Their current monthly income 
   
          ☐ If anyone is unemployed, the dates they have been unemployed 
 
Housing Information
 
 ☐ The amount of rent you are supposed to pay each month 
   
☐ The number of bedrooms in your housing 
   
☐ Whether or not your housing is subsidized 
   
☐ The amount of rent you currently owe your landlord 
   
☐ The month for which you have not paid your rent 
 
Utilities Information
 
 ☐ If you are asking for help with utilities, a list of which utilities and how much you owe them each 
 
Documents
 ☐ Copy of your lease, if you are asking for rental assistance 
☐ Copy of proof of income (such as W-2, last month's pay stubs, or tax form) 
☐ Copies of utility bills, if you are asking for utilities assistance