CLIENT FORMS

If you have received a call from a team member to move to the next phase of the application process, you will need to complete the following forms and upload or send verification documentation:

  1. Program Application (download here)

  2. Self Declaration (download here)

  3. Photo Identification

  4. Copies of Bank Statement for requested period

  5. Verification of Household Members (ex. lease)

  6. Copy of current lease/mortgage statement/utility bill

  7. Documentation to support COVID-19 Financial Impact that resulted in one of the following:

    • Loss of Employment

    • Reduction in work hours

    • Furlough from employment

    • Reduction in income/salary due to reduced business revenue​​:​​​​

      • Proof of Unemployment Insurance Benefits

      • Past pay stubs prior to COVID-19 and current pay-stubs to demonstrate loss of income​

      • Bank Statements indicating loss of income

      • 2019 Filed Income Tax Return

  8. Landlord Forms need to be sent directly from Landlord to Case Manager.  Assigned Case Managers will contact landlord for the best method of submission.

All client forms and verification may be emailed directly to your Case Manager, faxed to 844-582-4477  or uploaded here,

© 2018 by Southern Nevada CHIPs