Emergency Rental Assistance Program

Emergency Rental Assistance Program
Landlord Contact Information

If you are a Landlord with a tenant who is experiencing financial hardship in meeting housing cost payments due to the COVID-19 Pandemic, please complete this form so your information is on file with the Rockland County Department of Social Services.

Currently, this program is in the planning phase, however, by providing your contact information we will update you as information becomes available.
Name*

First NameLast Name
Business Address*

Street Address

Apartment #

CityState / Province

Postal / Zip Code
Email*
example@example.com
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Should be Empty:

Landlord Contact Information