Breaking New Ground Application Name First Initial Last Name Have you already been approved for RRH? Yes No Date Approved: MM slash DD slash YYYY Is this your first time receiving Rapid Re-Housing assistance? Yes No Please ExplainCan you pay rent online or digitally every month using a credit or debit card, Venmo, etc.? Yes No Please ExplainAre you interested in enrolling in LMM’s Health & Wellness or Workforce Development services? (This will not impact eligibility or selection) Yes No Applicant Signature:Applicant Date: MM slash DD slash YYYY Case manager Signature:Case manager Date: MM slash DD slash YYYY
