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Columbia Housing Center Registration Form
Please complete this form that will provide the Columbia Housing Center the information necessary to begin assisting you with your apartment search. The Columbia Housing Center's mission is to champion and sustain thriving, racially integrated communities in Columbia. Information provided in this form is confidential and will not be shared with property managers or owners. Our free rental referral resource will help you explore parts of Columbia you may not have known about. Our staff will help you find rental options that meet your needs and align with our mission. The Fair Housing Act, 42 U.S.C. 3601 et seq., prohibits discrimination by direct providers of housing, prohibits discrimination concerning the sale, rental, and financing of housing based on race, religion, national origin, sex, handicap, and family status. A primary goal of the Fair Housing Act is to achieve a housing market in which a person's background does not arbitrarily restrict access. The Fair Housing Act is in place to protect buyers and renters from seller and landlord discrimination. Fair Housing is a core tenet of the Columbia Housing Center and our apartment referral program.
About You/Contact Information
Name
*
First Name
Last Name
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where do you currently reside? Please select the answer that fits your situation best.
*
Please Select
Baltimore City
Baltimore County
Anne Arundel County
Carroll County
Howard County
Montgomery County
Frederick County
Prince George's County
Other county in Maryland
Outside of Maryland
Washington, D.C.
Current Zip Code
*
Best Phone Number To Reach You
*
Please enter a valid phone number.
Email
*
example@example.com
Best Time to Contact You
*
Morning
Afternoon
Evening
How did you hear about the Columbia Housing Center?
CHC website
Google Search
Housing Counselor or Case Manager
Client of Columbia Housing Center
Community Outreach Event
Howard Community College referral
Other
Are you a full time student and receiving housing assistance through loans and/or parental support?
*
Yes
No
Are you a female head of household (the member of the family who has been designated by the family as the head for purposes of determining income eligibility and rent)?
*
Yes
No
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Your Household Income and Credit History
Help us understand your housing budget and how your credit score may help or hinder your home search.
MONTHLY Total Combined Household Income (before taxes)
*
Note: This is the amount you bring home each MONTH, not your annual income. If you are paid bi-weekly, multiply the gross pay (before taxes are taken out) from your paycheck x26, then divide that number by 12. You can also visit https://calculator.me/planning/biweekly-to-monthly.php to get an estimate. Enter the Untaxed Monthly number here.
Monthly Rental Budget (30% of monthly income)
This field is calculated automatically - do not change this number!
Your credit score (if known)
To get a free estimated credit score, you can visit https://www.myfico.com/credit-education/credit-scores/free-credit-scores.
If you do not know your exact credit score, please select your current credit rating to the best of your knowledge:
Very Good/Excellent (740 or higher)
Good (670-739)
Fair (580-669)
Poor (Less than 579)
I'm not sure
No credit score established
How much do you currently pay for your monthly rent?
*
Total number of persons (including children) to occupy rental unit?
*
Remember to include yourself in this number! If you are expecting a child, please include that child in this number.
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Your Home in Howard County
Tell us what you are looking for in your new home and share any specific amenities needed
Total number of persons (including children) to occupy rental unit?
*
Please Select
1
2
3
4
5
6
7
8
9
10
11+
Remember to include yourself in this number! If you are expecting a child, please include that child in this number.
When is the earliest date you can move?
*
-
Month
-
Day
Year
Date
When is the latest date you can move?
*
-
Month
-
Day
Year
Date
Total number of bedrooms desired?
*
Do you require pet-friendly listings?
*
Yes, allows cats
Yes, allows dogs
No
If you said "Yes, allows dogs", please specify the number of dogs and their weights & breeds.
Are there other special requirements or amenities requested?
What village(s) are you interested in moving to?
*
Dorsey's Search
Harper's Choice
Hickory Ridge
Kings Contrivance
Long Reach
Oakland Mills
Owen Brown
River Hill
Town Center
Wilde Lake
Unsure
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Special Circumstances
Tell us about anything that might impact your home search, or that we should consider when providing housing referrals.
Are you using a Housing Choice Voucher?
*
Yes
No
If yes, which Housing Authority provided the voucher?
Are you receiving any type of case management or navigation services?
*
Yes
No
If yes, what organization or agency have you been working with? Please provide a contact name if possible.
Have you ever been evicted?
*
No
Yes
If evicted, when did this happen (year only). If you have never been evicted, please enter N/A here.
*
Did your Eviction happen in the state of Maryland?
Yes
No
Did your Landlord provide a reason for evicting you?
Yes
No
If you were provided with a reason, what was it? Please select the most applicable option, or "Other" if you don't see the reason listed here.
Please Select
Late payment of rent (you paid late fewer than 4 times)
Late payment of rent (you paid late more than 4 times)
Damage to leased premises
Violating community rules
Refusing to allow access to your unit
Landlord selling property
Landlord moving themselves or family into unit
Landlord planning extensive renovations
Other
If you chose "Other" above, please share the reason given for your eviction.
Are you (or another household adult) of Hispanic / Latinx ethnicity?
*
Yes
No
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Demographic Information
This information helps us accurately report our impact to funders. This information is never shared outside of CHC with your personal information attached to it. All data is anonymized to protect individual privacy.
Racial Identity: Please indicate the number of people living in the household (including children) that correspond with the following races/ethnicities. PLEASE DO NOT ENTER MORE THAN ONE NUMBER PER PERSON PER ROW. The total number of entries should match the total number of people in the household.
*
Number in Household (non-Hispanic)
Number in Household (also Hispanic)
White: A person having origins in any of the original people of Europe, the Middle East, or North Africa
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Black/African American: A person having origins in any of the black racial groups of Africa or the Caribbean
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Asian: A person with origins in any of the peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example: Afghanistan, Bangladesh, Cambodia, China, India, Japan, Korea, Laos, Malaysia, Mongolia, Pakistan, Philippine Islands, Thailand, and Vietnam
1
2
3
4
5
6
7
8
9
10
1
2
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5
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10
American Indian/Alaskan Native: A person having origins in North, Central or South America who maintains a tribal community attachment (not just claim of ancestry)
1
2
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5
6
7
8
9
10
1
2
3
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5
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Native Hawaiian/Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
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10
American Indian or Alaska Native AND White
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
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7
8
9
10
Asian AND White
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Black/African American AND White
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
American Indian/Alaska Native AND Black/African American
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
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10
Other/not listed
1
2
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4
5
6
7
8
9
10
1
2
3
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5
6
7
8
9
10
Newsletter
Yes, subscribe me to the Columbia Housing Center client e-mail list.
You accept disclosure of your new address (or nearest cross streets) as terms of agreement for our service.
*
Submit
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