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Homelessness Assistance Form

  1. Please select where you slept last night:*
  2. What is your household's hardship?*
  3. Please take a moment to make sure all your contact information was typed in correctly and all fields are filled in. This application is only for Homelessness Assistance. If you are in need of Rent or Mortgage Assistance and live in the City of Irving, go "Back" and choose the correct application.
  4. Leave This Blank:

  5. This field is not part of the form submission.