Tenant Mediation Registration

Eviction Prevention Mediation

We are here to help tenants come to a positive resolution with their landlords by opening the channels of communication with their landlord. Our mediation services can benefit both parties and, oftentimes, help come to a positive resolution for all.

If you have experienced financial hardship during COVID-19 and are at risk of being evicted, fill out the intake form below to begin working with a mediator.

Learn More About NNCEPP
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Documents You Will Need

  • ID
  • Lease Agreement
  • Proof of Income (if applicable)
  • Unemployment eligibility (if applicable)
  • Positive COVID-19 test result (if applicable)

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Instructions for Tenants

This declaration is for tenants, lessees, or residents of residential properties who are covered by Declaration of Emergency Directive 036 issued by Governor of the State of Nevada Steve Sisolak and effective December 15, 2020.Download Now »
Applicant Details

Contact Details

Address Information

Additional Household Member Information
Person (1)

Person (2)

Person (3)

Person (4)

Person (5)

Delinquency Details

Rental Assistance

Employment Details

Covid-19 Eviction Prevention Program Consent to Release or Obtain Information

I authorize NORTHERN NEVADA COVID-19 EVICTION PREVENTION PROGRAM (NNCEPP) to release or obtain the following information:

1. Information about my employment and income
2. Information about my rental history

This information may be used only for the purposes of mediation and/or rental assistance (if applicable)

I confirm that the information provided in my NNCEPP Information Sheet is true and complete. I understand that providing false or inaccurate information is grounds for rejection of mediation and/or rental assistance (if applicable).

Disclaimer
Imperium Property Management & Consulting LLC is providing mediation services. NNCEPP does not guarantee financial assistance from any resources.

Privacy Policy
CEPP provides this privacy policy to inform you of our policies and procedures regarding the collection, use and disclosure of personal information. For the purposes of this privacy policy, “Personal Information” means information that can be used to uniquely identify you, such as your name and email address.
We mainly use your personal information either alone or in combination with other information so that we can provide, enhance and personalize our services to you. We may collect, use, transfer and disclose information in a form that does not personally identify you (“non-identifying information”) for any purpose.
We will not share your personal information with other companies or individuals outside of NNCEPP unless we have received your consent. Non-identifying information may be provided to third parties for data collection and research purposes.
We adhere to Fair Housing Laws and guidelines where applicable.

I have read and agree to the terms stated above.
I agree that all of my answers are true and correct to the best of my knowledge.

Documents

ID:

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Lease Agreement:

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Proof of Income (if applicable):

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Unemployment eligibility (if applicable):

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Positive COVID-19 test result (if applicable):

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