Family Life Center Covid-19 Emergency Rental Assistance Application

Please use this form to apply for COVID-19 Emergency Rental Assistance.

COVID-19 Emergency Assistance

You can download and print the Covid-19 Emergency Assistance form with the button below.

Please attempt to use the online form first. Only print and mail in this form if necessary. 

You will need Adobe Acrobat Reader or a similar .pdf reader to view and print the file.


Completed forms can be mailed to:

Family Life Center

95 S. Kane St
Kahului, HI 96732

COVID-19 Emergency Rental Assistance

This form must be filled out by each Family requesting COVID-19 Emergency Rental Assistance. Please use the online form below. This form will submit directly to FLC when it is complete.