Providence Mission Homes

Providence Mission Homes

Housing Application
Application Date *

Month Day Year
Applicant Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
Arrival Date at PMH *

Month Day Year
Departure Date from PMH *

Month Day Year
RESIDENT FAMILY INFORMATION

Please provide information on the family who would like to stay with us.
The pricing per month and the security deposit are broken down as follows:

1 Bedroom Apartments - $750/month rent; $700 security deposit
2 Bedroom Apartments - $850/month rent; $800 security deposit
3 Bedroom Apartments - $950/month rent; $900 security deposit
Location Preference (if any)
Number of Bedrooms Desired
Family Member Information *
MISSION INFORMATION

Please provide information about your mission agency.
Field Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mission Name and Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
U.S. Address or Contact *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Will this be a study furlough? *

Yes No
If yes, how long?
Name of School
Field of Study
Describe your work as a missionary *
Outline your plans during furlough *
What are your plans once furlough has ended? *
AGREEMENTS

Please carefully read the following and sign to indicate your agreement to abide by these statements.
Eligibility
Because of the limited number of furnished apartments, Providence Mission Homes (PMH) is only able to house those persons who are missionaries with a RECOGNIZED and REGISTERED mission agency, and who are coming to Pasadena on a temporary furlough from their cross-cultural ministry and RETURNING to cross-cultural ministry overseas.

• PMH is unable to house persons who are living in the U. S. (not on temporary furlough) and are working for a U. S. based mission, state-side.
• PMH is unable to house persons who work and will return to their own country but are not actively engaged in cross-cultural ministry.

Please sign confirming that you are a cross-cultural missionary coming directly from your overseas field, and returning to a field after your short stay with us and that you, in accordance with the above paragraphs, are eligible for housing at PMH.
1. Eligibility Signature *

First Name Last Name
Date of eligibility confirmation *

Month Day Year
Community Life

Providence Mission Homes is a missionary community that is organized to provide temporary subsidized housing for missionaries coming home for short furloughs.

Therefore, if accepted as part of the PMH community, I/we agree to promote community life by attending occasional dinners, assisting with small community service jobs, and participating in group activities.
2. Community Life Signature *

First Name Last Name
Date of Community Life Signature *

Month Day Year
Date
Should be Empty:

Providence Mission Homes

RESIDENT FAMILY INFORMATION

MISSION INFORMATION

AGREEMENTS