L.E.G.A.C.Y. TENANT/LANDLORD – PARTICIPANT REGISTRATION This registration form is for the Tenant or the Landlord to fill out. Every field must be completed so that we can process your application. Once your registration form is complete, please read the Waiver of Liability Form and then submit your application. Registration forms will be processed within 2-3 business days, 72 hours of receipt. Please be patient with this process. We are working diligently to assist you during this time. Registration applications can only be submitted for those residing in Davidson County, TN.GENERAL INFORMATIONI am the* Tenant Landlord Is there a pending eviction case in General Sessions Court?* Yes No What is the pending General Sessions Court docket or case number?Email*Please enter the email address of the person who is registering. Cell or best phone number to be reached*Please enter the cell or best phone number to be reached for the person registering.PLEASE FILL OUT THE TENANT INFORMATIONFirst Name*Last Name*Cell or best phone number to be reachedContact number for tenant.Tenant Email Property Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many months is the tenant behind on rent?How much does the tenant owe?Tenant Date of Birth* Month Day Year Tenant Ethnicity/Race. Please select that which applies to you:African American/ BlackWhite/Non- HispanicAsian/Pacific IslanderHispanic/Latino (a)Middle Eastern/ArabicNative AmericanBiracial/OtherPlease choose your individual yearly income. Please check the box that applies to you:Less than $10,000$10,000 - $19,000$20,000 - $29,000$30,000 - $39,000$40,000 - $49,000Over $70,000Tenant Household Size: How many adults currently stay in your home?Does your family receive any State Benefits (such as TennCare, SNAP, Families First,etc.)? Yes No Tenant Household Size: How many children under the Age of 18 currently stay in your home?Does your family pay all or part of your rent using a housing voucher or another rental assistance program (i.e. Section 8 voucher) ?Please check the box that indicates why the tenant's income was decreased: (Check all boxes that apply) Laid off work Furloughed Lost Hours Gig work unavailable Temporarily unable to work due to COVID diagnosis (self or family) Changed employers due to COVID-19 and make less $$ Temporarily unable to work due to a required quarantine Loss of daycare Unable to work due to school age children in the home Assistance Needed: Mark all that apply Rent Payment Mortgage Payment Utility Payment Do you need legal advice? Yes No Do you need your rights restored? Yes No Do you want to participate in the L.E.G.A.C.Y. 1st Time Homebuyer’s Program? Yes No PLEASE FILL OUT THE LANDLORD INFORMATIONLandlord Business NameLandlord/ Business ContactFirst Name*Last Name*Cell or best phone number to be reachedLandlord contact number.Landlord Email Property Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional CommentsUse this area to share any additional information with us as we seek to assist you with accessing funds for non-payment of rent regarding this lease agreement. WAIVER OF LIABILITY FORM Please click here to read the WAIVER AND RELEASE OF LIABILITY FORM. By submitting your application and registering for the L.E.G.A.C.Y. Housing Resource Diversionary Court/Program you acknowledge that you have completely read and fully understand the above release and waiver of liability and agree to be bound by its terms and conditions.APPLICATION RESPONSE TIMEPlease be advised that your application will be processed and assigned to a case manager within 2-3 business days. You should expect a call or email from the L.E.G.A.C.Y. Housing Resource Diversionary/Program Court Team within 72 hours. Please be patient with the team as we are working diligently to assist you during this time. Should you have any questions or concerns please go to our website and click on the L.E.G.A.C.Y. HOUSING RESOURCE DIVERSIONARY COURT & PROGRAM BUTTON. THERE YOU WILL FIND LINKS TO RESOURCES & ANSWERS TO FREQUENTLY ASKED QUESTIONS AND WHAT TO EXPECT. SUBMIT YOUR REGISTRATION FORM BY CLICKING THE BUTTON BELOW, YOU SHOULD RECEIVE A REGISTRATION CONFIRMATION LETTER WITHIN 30 MIN OF SUBMITTING YOUR APPLICATION.Registration is NOT OPEN.
