HOUSING SERVICES APPLICATION

OVERVIEW:
Laurel Hill Center (LHC) has housing assistance programs available to individuals participating in LHC behavioral health services. By completing this application and the subsequent eligibility screening, you will be placed on a waitlist. The waitlist uses preference scoring to determine the placement of your application. 

Visit our website, Laurel.org, for information on all LHC housing opportunities including housing available to people not receiving LHC behavioral health services. 

WHAT TO EXPECT NEXT:
Within 2 weeks of submitting this application, an LHC Navigator will contact you to schedule an eligibility screening. This screening consists of questions about your housing preferences, needs, and history. We will ask questions that will help us identify eligibility and the best program(s) or type of housing for you. You may choose to opt out of the screening all together, however, please understand that you will not be placed on the waitlist unless you complete this step. 

NOTE ABOUT AUTHORIZED PERSONS:
If you are currently working with another agency, or you have an advocate, friend, or family member who you would like for us to be able to communicate with on your behalf in regards to your housing application and process, please fill out and sign the Authorization to Use and Disclose Housing Information: Advocate form attached to this application. We cannot speak to or give any information to anyone who we do not have a signed authorization for. If you have any questions about this process, please contact the Housing team at housingservices@laurel.org. 

EQUAL HOUSING OPPORTUNITY: Laurel Hill Center’s housing is program housing specifically for individuals who meet eligibility criteria for LHC services and participate in its programs. LHC complies with the Fair Housing Act. The information in this packet will assist us in helping you address past barriers to successful tenancy so that when you transition to independent living, you will have removed common barriers to housing.

** Whether by phone, email, or mailing address, you must provide at least ONE complete method of contact or else your application will be considered incomplete **

RENTAL ASSISTANCE PROGRAM (RAP)

• Monthly income required
• Applicant does NOT have to be an LHC client
• For individuals ONLY (no families or households of more than one)

LAUREL HILL CENTER PROGRAM HOUSING

• Monthly income required (or another source of rent assistance)
• Applicant MUST be an LHC client when pulled from the waitlist
• Includes both single and shared units for individuals, and 2-bedroom units for families
• Must pay $10 background check fee (per adult) if a unit is offered and accepted

In order to be eligible for any of the Laurel Hill Center Housing Programs you must meet the definition of homeless or at risk of homelessness based on the following guidelines.

Literally Homeless      

• Has a primary nighttime residence that is a public or private place not meant for human habitation
• Is living in a publicly or privately operated shelter designated to provide temporary living arrangements (including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state and local government programs)
• Is exiting an institution where (s)he has resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution. 

At serious risk of becoming homeless

• Paying more than 50% of the household's monthly income toward rent (rent burdened)
• Living in time-limited housing that is not meant to be permanent or is considered "transitional."
• Has moved because of economic reasons two or more times during the 60 days immediately preceding the application for homelessness prevention assistance
• Is living in the home of another because of economic hardship
• Has been notified in writing that their right to occupy their current housing or living situation will be terminated within 60 days of the date of application for assistance
• Lives in a hotel or motel and the cost of the hotel or motel stay is not paid by charitable organizations or by federal, State, or local government programs for low-income individuals
• Lives in a single-room occupancy or efficiency apartment unit in which there reside more than two persons, or lives in a larger housing unit in which there reside more than 1.5 people per room, as defined by the U.S. Census Bureau
• Is exiting a publicly funded institution, or system of care (such as a health-care facility, a mental health facility, foster care or other youth facility, or correction program or institution

By signing this application, I authorize Laurel Hill Center Housing Department and Laurel Hill Center Behavioral Health Programs to exchange information for the duration of my participation in the housing program. I understand that I may choose not to allow any authorizations and that my choice not to allow authorizations will not affect my ability to receive services. I understand that this authorization will remain in effect while I am a tenant in Laurel Hill Center Housing, and I can revoke this authorization in writing at any time; however, any such revocation will not apply to any activity previously undertaken based on this authorization. 

Including but not limited to, below are a few examples of information that may be exchanged between Housing and Behavioral Health Staff:

• Information about my housing account including rent, pro-rated rent, fees, and security deposit
• Results of unit inspections
• Copies of warnings and notices
• Information about complaints made against me as a tenant or made by me as a tenant about the property or activities on the property
• Information about incidents that occur at my residence or on the property related to me
• Any information related to my housing needs
• Letters of support and certification of completed programs
• Legal Documents & Income (ID, Social Security Card, SSI award letters, paystubs, etc.)
• Request for Accommodation/Modification
• Service/Companion Animal documentation
• Copies of all housing correspondences
• Information related to Behavioral Health Enrollment Status

★ By signing this application, I understand that I will be contacted for an eligibility screening. Applicants will be prioritized according to established contract requirements, policies, and procedures. I also understand that it is my responsibility to contact LHC should my contact information, household composition, or eligibility information change. Failure to do so may result in loss of opportunity to apply for housing assistance or denial of housing assistance due to household or eligibility changes.

CERTIFICATION: The information provided on this application form is complete and true to the best of my knowledge. I understand that providing false information may lead to denial of this application, to termination of rental agreement (if falsehood is discovered after move-in), or to criminal prosecution. I understand that admission into a housing program is conditioned upon eligibility criteria set by state law, this site’s Tenant Selection Plan, and my payment of applicable rent and security deposit in advance of move-in.

I understand that, should I be accepted for admission into a housing program, I must not maintain any other residence anywhere after I move in. I further understand that this information will be verified and that I must keep the application current by notifying Laurel Hill Center of changes in address and preferential status.

Please fill out this page if you are working with another agency or with an advocate (family member, PCA, etc.) who you want us to be able to speak to at any point regarding your Housing Services application.

This form is optional, but it must be filled out if another agency is planning to pay any housing costs on your behalf. If you are unsure at this time if you will be getting assistance from another entity, or if you are unsure if you want to designate an advocate, we do have these forms available to fill out separately if/when needed.

You DO NOT need to fill this form out for other Laurel Hill Center staff or programs.

I authorize Laurel Hill Center Housing Department to disclose the following information to the above agency/advocate:

This release authorizes the entity or individual above to exchange information with, provide information to, and receive information from Laurel Hill Center for the duration my account with the entity or individual above is open for the purpose of housing navigation and to assist with support and services.

I understand that I may choose not to sign this authorization and that my choice not to sign will not affect my ability to receive services. I understand that I can revoke this authorization in writing at any time; however, any such revocation will not apply to any activity previously undertaken based of this authorization. This authorization will remain in effect while I am a tenant and/or my account remains open with the above listed entity, property manager, or individual unless revoked by me in writing.

By signing, I have read this authorization and understand it.

To prepare you for enrollment into Laurel Hill Center housing programs, please be aware that you will be required to provide the following documents. If you do not currently have an item that is listed below but is applicable to you, now is the time to work on obtaining the documentation so that you don't miss out on any potential housing opportunities in the future. You are welcome to attach the documents below, or you can email them directly to the Laurel Hill Center Housing Department at housingservices@laurel.org at any time.

• Adults: Current, state-issued ID (not expired); US military discharge (DD 214); Current US passport; current employer identification card; certificate of birth; naturalization papers
• Children: Certificate of birth; naturalization papers; adoption papers; custody agreement; Health and Human Services ID; certified school records
• Social Security Card (or a document from a government agency with your name and SSN on it) for all family members
• Documentation for a live-in care provider
• Current documentation of all sources of income (Social Security award letter, pay stubs, at least three months of bank statements showing income deposits, etc.)
• Service/Companion Animal documentation from Provider (for each animal)
• Service/Companion Animal/Pet up-to-date vaccination records (for each animal)
• Service/Companion Animal/Pet license (for dogs only)
• Documentation for a request for housing accommodation for a physical disability (ground floor units, modifications, etc.)
• Records of treatment and/or letters of reference if you have been convicted of a felony
• Records of treatment and/or letters of reference if you have received a notice to vacate or been evicted from a property due to a disability.
• Documentation of money owed to a landlord and/or utility; money in collections; or bankruptcy in the last 7 years.
• Verification of assets (current financial statements for all accounts for all household members including checking and savings accounts, trust funds, retirement, investments, property, etc.)
• Education: Verification of enrollment status (full or part time) for all household members aged 18 or older. This must include verification of current financial aid award amount or proof that you are not receiving financial aid. If you accepted Federal Work Study and you are NOT receiving it, provide documentation from the school.