• YMCA of Reading & Berks County

    YMCA of Reading & Berks County

    Housing Application

  • Our Mission: To put Judeo-Christian principles into practice through programs that build healthy spirit, mind and body for all.

    Programs are collaborative projects of the County of Berks, City of Reading, Department of Public Welfare, Council on Chemical Abuse, Service Access Management, Inc., Housing and Urban Development, Federal Home Loan Bank, and Berks County Probation. EHO. The Bridge and SAFE Houses are funded, in part, under a contract with the Pennsylvania Department of Health, County of Berks and the SCA. Basic data for use in this study were supplied by the Pennsylvania Department of Health, Harrisburg, PA, the County of Berks, and the Council on Chemical Abuse. The Department of Health, the County of Berks, and the Council on Chemical Abuse specifically disclaim responsibility for any analysis, interpretations, or conclusions. (Revised 8/18)

  • Overall Eligibility Criteria To be eligible for these programs (not including SRO), applicants must be:

    • Drug and alcohol free for at least 5 consecutive days Employable and willing to gain employment
    • Motivated to remain clean and sober
    • Able to participate in outpatient counseling Committed to setting goals and working to achieve them Berks County resident
  • Please review the criteria for the programs and check the one you are applying for:

  • Please complete the following questions to the best of your ability. For SRO complete only sections A, C, E, F, G, H, I, J.

  • A. Demographic Information

  • Date
     / /
  • Format: (000) 000-0000.
  • Birth Date
     / /
  • Gender
  • Are you a US citizen?
  • Do you have any children?
  • Do you have a birth certificate?
  • Do you have a Social Security Card?
  • Do you have a State ID?
  • Do you have a driver's license?
  • Are you legally able to work in the US?
  • Do you own a car?
  • If so, do you have car insurance?
  • Have you ever been a victim of domestic violence?
  • Do you currently have a PFA on anyone?

  • B. Housing Information

  • Have you ever lived in the building of the YMCA of Reading?
  • Have or do any of your relatives, friends or acquaintances live or work at the YMCA?
  • Have you lived in any emergency shelters, transitional programs, or halfway houses previously?

  • C. Financial Information

  • Have you ever applied for SSI/SSDI?
  • Do you have any outstanding debts for any of the following

  • D. Education & Training

  • Do you have a high school diploma?

  • E. Military History

  • Have you ever been in the military?

  • F. Employment History

  • G. Legal History

  • Have you ever been convicted of a crime?
  • Are you currently on Probation or Parole?
  • Are you involved in any way with the court system at present?
  • In the past?
  • Have you ever been involved with CYS

  • H. Physical Health History

  • Are there any medical problems that would limit your ability to work?
  • Allergies to Food or Medications?
  • Are you pregnant?
  • If so, due date?
     / /
  • Are you presently taking any medication?
  • Do you have health insurance?
  • Have you had a TB test?
  • If no, would you like to receive a TB test?
  • Have you received a COVID-19 vaccination?
  • If you have not received the COVID-19 vaccine, are you interested in being vaccinated?

  • I. Behavioral & Emotional Health

  • Have you ever been in outpatient treatment for mental health?
  • Have you ever been in inpatient treatment for mental health?
  • Have you had any thoughts, gestures, incidents, or attempts at suicide or homicide?

  • J. Alcohol and Drug Use

  • Are you involved in a recovery program?

  • Please answer the following questions as thoroughly as possible.

  • Who should we contact in case of an emergency?

    Please list two contacts.
  • Did anyone assist you in completing this application?

  • By signing below, I verify that the information on my application is accurate and truthful. In addition, I understand that at any time during the application and interviewing process or after acceptance into the YMCA Housing Program, if it is determined/discovered that I have lied on my application, I may become ineligible to apply or participate in the Housing Programs of the YMCA of Reading.

  • Date
     / /
  • Should be Empty: