HIP TRANSITIONAL HOUSING APPLICATION

TRANSITIONAL HOUSING APPLICATION
Dear Applicant,

Thank you for your interest in Housing Initiatives of Princeton’s (HIP) Transitional Housing program. Your first step toward joining this program is to complete and submit this preliminary application. Please answer all questions in the application and if a section does not apply to you, please write “N/A.”

Your completed application will be timestamped and based on eligibility, you may be invited to interview when a unit becomes vacant. In the event that there are no vacant units, we will maintain a waitlist and review applications from the waitlist when a unit becomes available.

If your mailing address, email, income, family size, and/or phone numbers change, please let us know so that we can reach you when a unit becomes available. Contact information for HIP’s offices is below.

Thank you for applying.

Lori Troilo, Executive Director

info@housinginitiativesofprinceton.org | 609-921-2328

33 Mercer Street, Princeton NJ 08540

What we provide

HIP is more than just a housing provider. Clients agree to dedicate time and energy into taking full advantage of the robust set of services we offer (financial counseling, career coaching, tuition assistance, affordable housing navigation, and more).

Housing Supports While in the Program
- An apartment with subsidized rent for 12 months with a possible extension for a second 12 months
- Paid utilities
- Support in registering with area affordable housing waiting lists
- Internet connection
Support in Achieving Goals Set By Clients
- Individualized case management from our social worker
- Support in finding a better paying job, including job search, resume and cover letter writing, interview prep
- Credit counseling and budgeting assistance to help reduce debt and improve credit scores
- Support and advocacy for children in the program
- Social gatherings for families to create connections with each other
Assistance When Graduating from the Program
- Help in finding permanent, affordable housing when leaving program
- Security deposit and/or first month’s rent at the time of transition to permanent housing
Support in Accessing Partner Services
- Referrals to professional therapy, upon request
- Support in accessing food pantries of partner organizations
What we expect from Clients
- Clients pay rent – 30% of gross pay – due on the 1st of the month
- Twice monthly communication with our Social Worker
- Regular communication with volunteer liaison/advocate
- Monthly meetings with a Credit/Budget counseling professional
- Complete and mail affordable housing applications within two months of starting the HIP program
- Provide access for quarterly inspections. These inspections are a brief but important chance for us to ensure that each apartment is being maintained properly
- Work collaboratively our Social Worker to achieve your goals while in the program
- Help us by letting us know how we can strengthen the program and better support our clients
Sign here if you understand and agree to these program expectations before beginning the application.
Signature*

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Name*
Date*

MonthDayYear

HOUSING INITIATIVES of PRINCETON TRANSITIONAL HOUSING APPLICATION

Princeton, Mercer County, New Jersey
Please answer all questions in order for your application to be considered. If a section does not apply to you, please write “N/A".
APPLICANT INFORMATION
Name *

First NameLast Name
Phone Number*
Email*
example@example.com
Address (Enter "N/A" if unhoused.)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Age
Gender

HOUSEHOLD INFORMATION
Number of Adults (ages 18+) in Household (including yourself)*
Number of Children in Household*
List all other members of your household (excluding yourself), their relation (husband, daughter, etc.) and age
Additional Household member #1
Relation
Age
Check one:

Continue entering household membersAll household members have been entered

Additional Household member #2
Relation
Age
Check one:

Continue entering household membersAll household members have been entered

Additional Household member #3
Relation
Age
Check one:

Continue entering household membersAll household members have been entered

Additional Household member #4
Relation
Age
Check one:

Continue entering household membersAll household members have been entered

Additional Household member #5
Relation
Age

CURRENT HOUSEHOLD GROSS INCOME INFORMATION
Total Household Annual Gross Income (Before taxes and deductions): *
Please include income from all jobs, pension, Social Security, Disability, Child Support, NJ Unemployment, SNAP, LIHEAP of ALL household members (HH).
Income Source*
Average amount per month*
Household member*
Additional sources of income?

YesNo

Income Source
Average amount per month
Household member
Additional sources of income?

YesNo

Income Source
Average amount per month
Household member
Additional sources of income?

YesNo

Income Source
Average amount per month
Household member
Additional sources of income?

YesNo

Income Source
Average amount per month
Household member

HOUSEHOLD DEBT
What Credit Card accounts do you have?
Amount Owed on Credit Cards*
Loans (and Type of Loan)
Amount Owed on Loans*
Other (child support, bankruptcy, etc.)
Amount Owed on Other*
Specify debt details here:

HOUSEHOLD EXPENSE INFORMATION
Not limited to, but including rent/mortgage, electric/gas, phone, internet, food, transportation, etc. of ALL Household Members
Total Monthly Expenses*
Monthly Rent Expense*
Monthly Electric/Gas Utilities Expense*
Monthly Communications (Phone, Internet,TV) Expense*
Monthly Food Expense*
Monthly Transportation(Car, Gas, Insurance, etc.) Expense*

Other Monthly Expense 1
Other Monthly Expense (Specify)
Other Monthly Expense Amount

Other Monthly Expense 2
Other Monthly Expense (Specify)
Other Monthly Expense Amount

Other Monthly Expense 3
Other Monthly Expense (Specify)
Other Monthly Expense Amount

ADDITIONAL INFORMATION - HEAD OF HOUSEHOLD
Name

First NameLast Name
EDUCATION
High School Diploma*

YesNo
Technical Certificate*

YesNo
Major
School or College
Type of degree earned
Years attended (if in past 7 years): From: Starting Yearto: Ending Year
Post-secondary coursework (community college classes, job training programs, ESL classes, computer classes, etc.)
OCCUPATION
Current Occupation *
Employer Name (Enter "N/A" if currently unemployed.)*
Employer Address
Employer Phone Number
Do you have health insurance?*

YesNo
EMPLOYMENT HISTORY (PAST 7 YEARS)
1. Previous Employer
Position
Starting Date

MonthDayYear
Ending Date

MonthDayYear
2. Previous Employer
Position
Starting Date

MonthDayYear
Ending Date

MonthDayYear
3. Previous Employer
Position
Starting Date

MonthDayYear
Ending Date

MonthDayYear

ADDITIONAL INFORMATION: ADDITIONAL HOUSEHOLD MEMBERS

ADULT (HOUSEHOLD MEMBER 2)
ADULT (HOUSEHOLD MEMBER 2)
Name

First NameLast Name
Is this individual a co-applicant?

YesNo
EDUCATION
High School Diploma

YesNo
Technical Certificate

YesNo
Major
School or College
Type of degree earned
Years attended (if in past 7 years): From: Starting Yearto: Ending Year
Post-secondary coursework (community college classes, job training programs, ESL classes, computer classes, etc.)
OCCUPATION
Current Occupation
Employer Name
Employer Address
Employer Phone Number
Do you have health insurance?

YesNo
EMPLOYMENT HISTORY (PAST 7 YEARS)
1. Previous Employer
Position
Starting Date

MonthDayYear
Ending Date

MonthDayYear

CHILD 1
ADDITIONAL INFORMATION - CHILD 1
Name

First NameLast Name
Age
Highest grade completed in school
School or daycare where currently enrolled
Activities currently involved in (e.g. extracurricular activities)
Activities they would like to be involved in:

CHILD 2
ADDITIONAL INFORMATION - CHILD 2
Name

First NameLast Name
Age
Highest grade completed in school
School or daycare where currently enrolled
Activities currently involved in (e.g. extracurricular activities)
Activities they would like to be involved in:

CHILD 3
ADDITIONAL INFORMATION - CHILD 3
Name

First NameLast Name
Age
Highest grade completed in school
School or daycare where currently enrolled
Activities currently involved in (e.g. extracurricular activities)
Activities they would like to be involved in:

REFERENCES
PROFESSIONAL REFERENCES (e.g. CURRENT/FORMER EMPLOYER, TEACHER, ETC.)
Name

First NameLast Name
Phone Number
CURRENT LANDLORD REFERENCE
Landlord Name

First NameLast Name
Phone Number

SIGNATURE
I(We) certify that all statements made on this application form have been examined by me and to the best of my knowledge and belief are true, correct, and complete. I have no objection to inquiries being made for the purpose of verifying the facts stated in this application. Furthermore, I give my permission for HIP to perform a credit, landlord, and criminal background check as part of this application.

I understand that the filing of this application does not, in any way, bind HIP to reserve or assign an apartment to me.
Applicant*

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Date

MonthDayYear
Date
Co-Applicant (if applicable)

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Date

MonthDayYear
Date
PDF link
Type a question

	Not Satisfied	Somewhat Satisfied	Satisfied	Any thoughts?
Service Quality
Cleanliness
Responsiveness
Friendliness

TRANSITIONAL HOUSING APPLICATION

What we provide

HOUSING INITIATIVES of PRINCETON TRANSITIONAL HOUSING APPLICATION

APPLICANT INFORMATION

HOUSEHOLD INFORMATION

CURRENT HOUSEHOLD GROSS INCOME INFORMATION

HOUSEHOLD DEBT

HOUSEHOLD EXPENSE INFORMATION

ADDITIONAL INFORMATION

ADDITIONAL INFORMATION - HEAD OF HOUSEHOLD

ADDITIONAL INFORMATION: ADDITIONAL HOUSEHOLD MEMBERS

ADULT (HOUSEHOLD MEMBER 2)

ADDITIONAL INFORMATION - CHILD 1

ADDITIONAL INFORMATION - CHILD 2

ADDITIONAL INFORMATION - CHILD 3

REFERENCES

SIGNATURE