City of La Mesa Older Adult Rental Assistance Program

City of La Mesa - Older Adult Rental Assistance Program

Application
The priority deadline is April 4, 2025. Program funding is limited, and applications will be processed by a lottery system based on eligibility and priority eligibility.
Name*

First NameLast Name
Date of Birth (MM/DD/YY)*

MonthDayYear
Head of Household must be 55 years or older
Street Address*
Your Home Address where you Rent/Lease
Unit / Apartment Number
City*
State Province*
Postal Zip Code*
Must be in the City of La Mesa
STOP! You must live in the incorporated City of La Mesa (91941 and 91942).
Do you currently RENT with a lease/rental agreement?*

YesNo (Individuals MUST rent to be eligible)
STOP! You must be a renter with a lease or rental agreement to be eligible for the Older Adult Rental Assistance.
Are you receiving any other Rental Assistance or Subsidy? (HUD, Serving Seniors, County of San Diego, etc.)*

YesNo
STOP! If you are receiving other ongoing rental assistance, you are not eligible for the Older Adult Rental Assistance.
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Preferred Method of Contact*

PhoneEmail
May We Leave a Voicemail Message?*

YesNo
Landlord's Name*
Landlord's Phone Number*
Please enter a valid phone number.
Landlord's Email
example@example.com
Monthly Rent Amount ($)*
Start Date of Lease (MM/DD/YY)

MonthDayYear
Date
Household Information
Please provide the requested information for all household members who will be living in the unit, including yourself. List Head of Household first.

Household Information*

	Member 1 Head of Household	Member 2	Member 3	Member 4
Name
Age
Relationship to Applicant

Financial Information

Please provide monthly amount(s) of income for all household members*

	Member 1 Head of Household	Member 2	Member 3	Member 4
Employment Wages
Social Security
Pension/Retirement
Alimony/Child Support
Disability
Other

Total Monthly Income for the Household*
Percentage of Rent Burden (Auto Calculated)
Must be at 50% or higher
Additional Information
Reason for seeking Rental Assistance
Have you received rental assistance in the past? If yes, please provide details below
Are there any extenuating circumstances affecting your ability to pay rent
Any other relevant information you would like to share
Please Read and Initial

Please initial your acknowledgement of each statement below:
I understand I will be asked to provide valid identification (current driver's license, a state issued photo ID, or a passport)*
Please upload Valid Identification (current DL, photo ID, or passport).

Cancelof
I understand I will be asked to provide income documentation which may include my most recent employment paystubs, SSI statements, disability statements, tax income filing, etc.*
Please upload Proof of Income (SSI, disability statement, most recent paystub, etc.)

Cancelof
I understand I will be asked to provide a copy of my entire Lease/Rental Agreement*
Please upload your entire Lease Agreement.

Cancelof
I understand that if eligible, my Landlord must be willing to participate in the program and provide necessary documentation including a W9. *
Should be Empty:

City of La Mesa - Older Adult Rental Assistance Program

The priority deadline is April 4, 2025. Program funding is limited, and applications will be processed by a lottery system based on eligibility and priority eligibility.

STOP! You must live in the incorporated City of La Mesa (91941 and 91942).

STOP! You must be a renter with a lease or rental agreement to be eligible for the Older Adult Rental Assistance.

STOP! If you are receiving other ongoing rental assistance, you are not eligible for the Older Adult Rental Assistance.

Household Information

Financial Information

Additional Information

Please Read and Initial